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Avgerinos N, Avgerinos I, Troupis T, Chrysikos D, Georgopoulos S. Carotid Body Tumor in a 26-Year-Old Male Patient Managed With Preoperative Embolization. Cureus 2023; 15:e49917. [PMID: 38058530 PMCID: PMC10696408 DOI: 10.7759/cureus.49917] [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] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Carotid body tumors are rare, highly vascularized neuroendocrine tumors that arise near the bifurcation of the common carotid artery (CCA). Controversy exists in the management of those tumors about whether preoperative embolization facilitates surgical excision and decreases perioperative complication risk. We present the case of a 26-year-old patient with a carotid body tumor manifesting as a painless pulsatile mass in the anterior triangle over the left side of the neck and provide details of the preoperative diagnostic steps. Treatment included preoperative embolization of the tumor followed by surgical excision after 48 hours to safely address this rare pathology, resulting in a favorable outcome for the patient.
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Affiliation(s)
- Nikolaos Avgerinos
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Ilias Avgerinos
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Vascular Surgery, Laiko General Hospital of Athens, Athens, GRC
| | - Theodore Troupis
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimosthenis Chrysikos
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Sotirios Georgopoulos
- Vascular Surgery, Laiko General Hospital of Athens, Athens, GRC
- Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Kokkinidis DG, Schizas D, Pargaonkar S, Karamanis D, Mylonas KS, Hasemaki N, Palaiodimos L, Varrias D, Tzavellas G, Siasos G, Klonaris C, Kharawala A, Chlorogiannis DD, Georgopoulos S, Bakoyiannis C. Differences between Lower Extremity Arterial Occlusion vs. Stenosis and Predictors of Successful Endovascular Interventions. Medicina (Kaunas) 2023; 59:2029. [PMID: 38004078 PMCID: PMC10673017 DOI: 10.3390/medicina59112029] [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] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: In patients with peripheral artery disease, there is insufficient understanding of characteristics that predict successful revascularization of the lower extremity (LE) chronic total occlusions (CTOs) and baseline differences in demographic, clinical, and angiographic characteristics in patients with LE CTO vs. non-CTO. We aim to explore these differences and predictors of successful revascularization among CTO patients. Materials and Methods: Two vascular centers enrolled LE-CTO patients who underwent endovascular revascularization. Data on demographics, clinical, angiographic, and interventional characteristics were collected. LE non-CTO arterial stenosis patients were compared. A total of 256 patients with LE revascularization procedures were studied; among them, 120 had CTOs and 136 had LE stenosis but no CTOs. Results: Aspirin use (Odds ratio, OR: 3.43; CI 1.32-8.88; p = 0.011) was a positive predictor whereas a history of malignancy (OR: 0.27; CI 0.09-0.80; p = 0.018) was a negative predictor of successful crossing in the CTO group. The CTO group had a higher history of myocardial infarction (29.2 vs. 18.3%, p = 0.05), end-stage renal disease (19.2 vs. 9.6%, p = 0.03), and chronic limb-threatening ischemia as the reason for revascularization (64.2 vs. 22.8%, p < 0.001). They were more likely to have advanced TransAtlantic Inter-Society Consensus (TASC) stages, multi-vessel revascularization procedures, longer lesions, and urgent treatment. Conclusions: The use of aspirin is a positive predictor whereas a history of malignancy is a negative predictor for successful crossing in CTO lesions. Additionally, LE-CTO patients have a higher incidence of comorbidities, which is expected given their higher disease burden. Successful endovascular re-vascularization can be associated with baseline clinical variables.
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Affiliation(s)
- Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sumant Pargaonkar
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Dimitrios Karamanis
- Department of Economics, University of Piraeus, 18534 Piraeus, Greece
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA
| | - Konstantinos S Mylonas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Natasha Hasemaki
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Georgios Tzavellas
- Department of Vascular Surgery, Ball Memorial Hospital, Muncie, IN 47303, USA
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Klonaris
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Amrin Kharawala
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
| | | | - Sotirios Georgopoulos
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Bobos D, Soufla G, Angouras DC, Lekakis I, Georgopoulos S, Melissari E. Investigation of the Role of BMP2 and -4 in ASD, VSD and Complex Congenital Heart Disease. Diagnostics (Basel) 2023; 13:2717. [PMID: 37627976 PMCID: PMC10453726 DOI: 10.3390/diagnostics13162717] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Congenital heart malformations (CHMs) make up between 2 and 3% of annual human births. Bone morphogenetic proteins (BMPs) signalling is required for chamber myocardium development. We examined for possible molecular defects in the bone morphogenetic protein 2 and 4 (BMP2, -4) genes by sequencing analysis of all coding exons, as well as possible transcription or protein expression deregulation by real-time PCR and ELISA, respectively, in 52 heart biopsies with congenital malformations (atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy ofFallot (ToF) and complex cases) compared to 10 non-congenital heart disease (CHD) hearts. No loss of function mutations was found; only synonymous single nucleotide polymorphisms (SNPs) in the BMP2 and BMP4 genes were found. Deregulation of the mRNA expression and co-expression profile of the two genes (BMP2/BMP4) was observed in the affected compared to the normal hearts. BMP2 and -4 protein expression levels were similar in normal and affected hearts. This is the first study assessing the role of BMP-2 and 4 in congenital heart malformations. Our analysis did not reveal molecular defects in the BMP2 and -4 genes that could support a causal relationship with the congenital defects present in our patients. Importantly, sustained mRNA and protein expression of BMP2 and -4 in CHD cases compared to controls indicates possible temporal epigenetic, microRNA or post-transcriptional regulation mechanisms governing the initial stages of cardiac malformation.
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Affiliation(s)
- Dimitrios Bobos
- Department of Pediatric Cardiothoracic Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece;
| | - Giannoula Soufla
- Department of Hematology and Blood Transfusion, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Dimitrios C. Angouras
- Department of Cardiac Surgery, Faculty of Medicine, Attikon University Hospital, National Kapodistrian University of Athens, 15771 Athens, Greece
| | - Ioannis Lekakis
- Second Department of Cardiology, Attikon Hospital, Athens Medical School, National Kapodistrian University of Athens, 15771 Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Laikon General Hospital, Medical School, National Kapodistrian University of Athens, 15771 Athens, Greece
| | - Euthemia Melissari
- Department of Hematology and Blood Transfusion, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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Patelis N, Matheiken S, Bisdas T, Jing Z, Feng J, Trenner M, Ocke Reis PE, Elkouri S, Lecis A, Le Roux D, Ionac M, Berczeli M, Jongkind V, Yeung KK, Katsargyris A, Avgerinos E, Moris D, Choong A, Ng JJ, Cvjetko I, Antoniou GA, Ghibu P, Svetlikov A, Ebben HP, Stepak H, Kostiv S, Ancetti S, Tadayon N, Fidalgo-Domingos L, Sarutte Rosello ES, Isik A, Kakavia K, Georgopoulos S. Vascular e-Learning in the MENA Region during the COVID-19 Pandemic. Dubai Med J 2023. [DOI: 10.1159/000529570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
<b><i>Introduction:</i></b> With the steady rise in interest in e-learning and the sudden boost provoked by the COVID-19 pandemic, it becomes necessary to explore the e-learning experience within the medical community in the MENA region. <b><i>Methods:</i></b> An online survey was conducted during the early phase of the COVID-19 pandemic (June 15 – October 15, 2020). <b><i>Results:</i></b> Seventy-eight vascular surgeons and trainees from 16 countries participated. 88% of the participants were male. 55% attended more than 4 activities. More than half of the activities did not lead to any official certification. Topic was the primary determinant for attending an activity. National societies and social media played a major role in disseminating activity-related information. Lack of time, increased workload, differences in time zone, and technical issues were the main obstacles cited. 84.7% of the participants had a positive impression. <b><i>Conclusion:</i></b> As the COVID-19 pandemic boosted e-learning activities in vascular surgery, a shift was observed in the learning mode and new leadership skills were called upon. Novel ways of quality control are required.
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Rokkas T, Georgopoulos S, Michopoulos S, Ntouli V, Liatsos C, Puig I, Nyssen OP, Mégraud F, O'Morain C, Gisbert JP. Assessment of first-line eradication treatment in Greece: data from the European Registry on Helicobacter pylori management (Hp-EuReg). Ann Gastroenterol 2022; 35:42-47. [PMID: 34987287 PMCID: PMC8713343 DOI: 10.20524/aog.2021.0670] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) is the most common chronic bacterial infection. Its management has to rely on local effectiveness, given the geographical variability of bacterial antibiotic resistance. We evaluated treatment effectiveness in naïve patients in Greece, as part of the European Registry on the management of H. pylori (Hp-EuReg). Methods Patients were registered in the AEG-REDCap Electronic Case Report Form from 2013-2020. All cases with a first-line treatment were included. Modified intention-to-treat (mITT) analysis was used. Results A total of 547 patients from 5 medical institutions were treated with the following regimens: concomitant with proton pump inhibitors (PPIs), clarithromycin, amoxicillin and metronidazole (concomitant-C+A+M) (38%); hybrid with PPI, clarithromycin, amoxicillin and metronidazole (hybrid-C+A+M) (20%); sequential with PPI, clarithromycin, amoxicillin and tinidazole (sequential-C+A+T) (12%); sequential with PPI, clarithromycin, amoxicillin and metronidazole (sequential-C+A+M) (12%); concomitant with PPI, clarithromycin, amoxicillin and tinidazole (concomitant-C+A+T) (8%); triple with PPI, clarithromycin and amoxicillin (triple-C+A) (7%); and other (3%). Overall compliance was 99%. Triple-C+A, sequential-C+A+T, sequential-C+A+M and concomitant-C+A+T were used from 2013-2015. The respective mITT cure rates (95% confidence interval) were 92% (78-98), 87% (76-94), 67% (54-78) and 91% (79-98). Since 2015, patients were also treated with concomitant-C+A+M and hybrid-C+A+M regimens, with respective mITT cure rates of 90% (85-94) and 88% (80.5-94). Adverse events were reported by 31% of the patients, dysgeusia being the most frequent (15%). Conclusions “Optimized” H. pylori therapies should achieve cure rates over 90%. In Greece, at present, only non-bismuth quadruple concomitant regimens achieve this target and can be recommended as first-line treatment.
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Affiliation(s)
- Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece (Theodore Rokkas)
| | - Sotirios Georgopoulos
- Department of Gastroenterology, Athens Medical Paleo Faliron Hospital, Athens, Greece (Sotirios Georgopoulos)
| | - Spyros Michopoulos
- Department of Gastroenterology, Alexandra's Hospital, Athens, Greece (Spyros Michopoulos)
| | - Vasiliki Ntouli
- Department of Gastroenterology, Tzaneio General Hospital of Piraeus, Piraeus, Greece (Vasiliki Ntouli)
| | - Christos Liatsos
- Department of Gastroenterology, 401 Military Hospital, Athens, Greece (Christos Liatsos)
| | - Ignasi Puig
- Department of Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain (Ignasi Puig)
| | - Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain (Olga P. Nyssen, Javier P. Gisbert)
| | - Francis Mégraud
- Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux, France (Francis Mégraud)
| | - Colm O'Morain
- Trinity College Dublin, Dublin, Ireland (Colm O'Morain)
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain (Olga P. Nyssen, Javier P. Gisbert)
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Christoforou PD, Bakoyiannis CN, Konidari M, Georgopoulos S, Kotsis T. Doppler is a Safe Criterion for Ensuring the Implementation of Eversion Carotid Endarterectomy. Ann Vasc Dis 2021. [PMCID: PMC8752923 DOI: 10.3400/avd.oa.21-00065] [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] [Indexed: 11/23/2022] Open
Abstract
Objective: This is a prospective study concerning patients with symptomatic or asymptomatic significant carotid stenosis. Preoperative and intraoperative measurements of the peripheral extension of the carotid atherosclerotic plaque have been compared with postoperative measurements to identify a preoperative method that safely allows the performance of eversion carotid endarterectomy (ECEA). Materials and Methods: The study included 37 patients with symptomatic internal carotid stenosis greater than 70% and 43 patients with asymptomatic stenosis greater than 80%. Four methods were used for establishing criteria: preoperative Doppler examination, intraoperative measurement of the carotid atheroma before artery division, measurement of the removed plaque, and histological measurement of the plaque. Results: Preoperative Doppler examination is a method of estimating the actual distal extension of the internal carotid artery (ICA) atheroma, with correction as dictated by the following formula:AL= 0.6704+0.7685⋅Doppler In all cases, preoperative ultrasound measurements and intraoperative estimation confirmed the correct decision to proceed with the eversion technique. Conclusion: The peripheral extension of the atherosclerotic plaque of the ICA can be assessed with accuracy by preoperative Doppler study, which can be used with safety as a predicting criterion of the existence of healthy peripheral carotid tissue that allows the performance of the eversion endarterectomy technique.
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Affiliation(s)
- Panagitsa D. Christoforou
- Vascular Department, 2nd Clinic of Surgery, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens
| | - Chris N. Bakoyiannis
- Vascular Department, 1st Clinic of Surgery, Laiko General Hospital, Athens Medical School, National and Kapodistrian University of Athens
| | - Marianna Konidari
- 1st Department of Radiology, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens
| | - Sotirios Georgopoulos
- Vascular Department, 1st Clinic of Surgery, Laiko General Hospital, Athens Medical School, National and Kapodistrian University of Athens
| | - Thomas Kotsis
- Vascular Department, 2nd Clinic of Surgery, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens
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Patelis N, Bisdas T, Jing Z, Feng J, Trenner M, Tri Nugroho N, Ocke Reis PE, Elkouri S, Lecis A, Karam L, Roux DL, Ionac M, Berczeli M, Jongkind V, Yeung KK, Katsargyris A, Avgerinos E, Moris D, Choong A, Ng JJ, Cvjetko I, Antoniou GA, Ghibu P, Svetlikov A, Pedrajas FG, Ebben H, Stepak H, Chornuy A, Kostiv S, Ancetti S, Tadayon N, Mekkar A, Magnitskiy L, Fidalgo-Domingos L, Matheiken S, Sarutte Rosello ES, Isik A, Kirkilesis G, Kakavia K, Georgopoulos S. Vascular e-Learning During the COVID-19 Pandemic: The EL-COVID Survey. Ann Vasc Surg 2021; 77:63-70. [PMID: 34478845 PMCID: PMC8407942 DOI: 10.1016/j.avsg.2021.08.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/25/2021] [Accepted: 08/05/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND The corona virus disease (COVID-19) pandemic has radically changed the possibilities for vascular surgeons and trainees to exchange knowledge and experience. The aim of the present survey is to inventorize the e-learning needs of vascular surgeons and trainees as well as the strengths and weaknesses of vascular e-Learning. METHODS An online survey consisting of 18 questions was created in English, with a separate bilingual English-Mandarin version. The survey was dispersed to vascular surgeons and trainees worldwide through social media and via direct messaging from June 15, 2020 to October 15, 2020. RESULTS Eight hundred and fifty-six records from 84 different countries could be included. Most participants attended several online activities (>4: n = 461, 54%; 2-4: n = 300, 35%; 1: n = 95, 11%) and evaluated online activities as positive or very positive (84.7%). In deciding upon participation, the topic of the activity was most important (n = 440, 51.4%), followed by the reputation of the presenter or the panel (n = 178, 20.8%), but not necessarily receiving accreditation or certification (n = 52, 6.1%). The survey identified several shortcomings in vascular e-Learning during the pandemic: limited possibility to attend due to lack of time and increased workload (n = 432, 50.5%), no protected/allocated time (n = 488, 57%) and no accreditation or certification, while technical shortcomings were only a minor problem (n = 25, 2.9%). CONCLUSIONS During the COVID-19 pandemic vascular e-Learning has been used frequently and was appreciated by vascular professionals from around the globe. The survey identified strengths and weaknesses in current e-Learning that can be used to further improve online learning in vascular surgery.
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Affiliation(s)
- Nikolaos Patelis
- Third Department of Vascular Surgery, Athens Medical Center, Greece; National & Kapodistrian University of Athens, Greece.
| | | | - Zaiping Jing
- Vascular surgery department, First affiliated hospital to Navy medical university, Shanghai, PR China
| | - Jiaxuan Feng
- Vascular surgery department, First affiliated hospital to Navy medical university, Shanghai, PR China
| | - Matthias Trenner
- Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Germany
| | - Nyityasmono Tri Nugroho
- Faculty of Medicine University of Indonesia - Cipto Mangunkusumo National Hospital, Indonesia
| | | | | | | | | | | | - Mihai Ionac
- University of Medicine and Pharmacy, Romania
| | | | | | | | - Athanasios Katsargyris
- Paracelsus Medical University, Klinikum Nurenberg, Germany; National & Kapodistrian University of Athens, Greece
| | - Efthymios Avgerinos
- University of Pittsburgh Medical Center, USA; National & Kapodistrian University of Athens, Greece
| | | | | | - Jun Jie Ng
- National University of Singapore, Singapore
| | | | | | | | - Alexei Svetlikov
- Vascular & endovascular surgery Center, National Scientific-Clinical Memorial Hospital, "Professor I.I. Mechnikov", North-Western Medical University, The Russian Federation
| | | | | | | | | | | | | | - Niki Tadayon
- Shahid Beheshti University of Medical Sciences, Iran
| | | | | | | | | | | | - Arda Isik
- Erzincan Binali Yildirim University, Turkey
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Kokkinidis DG, Katamreddy A, Giannopoulos S, Schizas D, Georgopoulos S, Liakakos T, Armstrong EJ, Bakoyiannis C. Risk Models and Scores in Patients with Peripheral Artery Disease and Chronic Limb-threatening Ischemia: A Comprehensive Review. Curr Pharm Des 2021; 27:1277-1288. [PMID: 32472995 DOI: 10.2174/1381612826666200530214459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022]
Abstract
Peripheral artery disease (PAD) affects more than 200 million patients worldwide and chronic limbthreatening ischemia (CLTI) is the most advanced stage of PAD with very high morbidity and mortality rates. Cardiovascular medicine is trending towards a more personalized approach where each individual patient will be managed according to specific risk factors, disease characteristics, expectations related to their disease and individualized assessment of potential outcomes. For this reason, a number of risk models and scores have been developed during the last few years. Our aim in this comprehensive review article is to provide an overview of selected risk models and scores for patients with PAD and CLTI. Given that some of the published scores were of low quality (minimal discriminatory ability), we included scores that were already externally validated or scores that had promising initial findings. Available scoring systems were grouped in the five following categories according to their utility: i) scores that can detect asymptomatic patients who should be screened for PAD, ii) scores for assessment of functional status and quality of life in patients with PAD, iii) scores assessing risk for amputation and other major adverse limb events among patients with CLTI, iv) scores for the optimal revascularization strategy in each patient and scores predicting successful procedural outcomes; v) scores predicting short or long-term cardiovascular and limb related outcomes after either revascularization or at least angiographic assessment. Limitations of available scoring systems include development and validation in specific populations, lack of external validation (for some of them) and also lack of synchrony with current era endovascular technology. However, with further optimization of current scores and the development of new scores, the field of PAD and CLI can be transitioned to a personalized medicine approach.
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Affiliation(s)
- Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Adarsh Katamreddy
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Aurora, CO, United States
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodore Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Aurora, CO, United States
| | - Christos Bakoyiannis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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9
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Nyssen OP, Perez-Aisa A, Tepes B, Castro-Fernandez M, Kupcinskas J, Jonaitis L, Bujanda L, Lucendo A, Jurecic NB, Perez-Lasala J, Shvets O, Fadeenko G, Huguet JM, Kikec Z, Bordin D, Voynovan I, Leja M, Machado JC, Areia M, Fernandez-Salazar L, Rodrigo L, Alekseenko S, Barrio J, Ortuño J, Perona M, Vologzhanina L, Romero PM, Zaytsev O, Rokkas T, Georgopoulos S, Pellicano R, Buzas GM, Modolell I, Gomez Rodriguez BJ, Simsek I, Simsek C, Lafuente MR, Ilchishina T, Camarero JG, Dominguez-Cajal M, Ntouli V, Dekhnich NN, Phull P, Nuñez O, Lerang F, Venerito M, Heluwaert F, Tonkic A, Caldas M, Puig I, Megraud F, O'Morain C, Gisbert JP. Adverse Event Profile During the Treatment of Helicobacter pylori: A Real-World Experience of 22,000 Patients From the European Registry on H. pylori Management (Hp-EuReg). Am J Gastroenterol 2021; 116:1220-1229. [PMID: 33840725 DOI: 10.14309/ajg.0000000000001246] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The safety of Helicobacter pylori eradication treatments and to what extent adverse events (AEs) influence therapeutic compliance in clinical practice are hardly known. Our aim was to assess the frequency, type, intensity, and duration of AEs, and their impact on compliance, for the most frequently used treatments in the "European Registry on Helicobacter pylori management." METHODS Systematic prospective noninterventional registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H. pylori infection in routine clinical practice. All prescribed eradication treatments and their corresponding safety profile were recorded. AEs were classified depending on the intensity of symptoms as mild/moderate/severe and as serious AEs. All data were subject to quality control. RESULTS The different treatments prescribed to 22,492 patients caused at least 1 AE in 23% of the cases; the classic bismuth-based quadruple therapy was the worst tolerated (37% of AEs). Taste disturbance (7%), diarrhea (7%), nausea (6%), and abdominal pain (3%) were the most frequent AEs. The majority of AEs were mild (57%), 6% were severe, and only 0.08% were serious, with an average duration of 7 days. The treatment compliance rate was 97%. Only 1.3% of the patients discontinued treatment due to AEs. Longer treatment durations were significantly associated with a higher incidence of AEs in standard triple, concomitant, bismuth quadruple, and levofloxacin triple or quadruple therapies. DISCUSSION Helicobacter pylori eradication treatment frequently induces AEs, although they are usually mild and of limited duration. Their appearance does not interfere significantly with treatment compliance.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Angeles Perez-Aisa
- Gastroenterology Unit, Agencia Sanitaria Costa del Sol, Marbella, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia
| | | | - Juozas Kupcinskas
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Luis Bujanda
- Gastroenterology Unit, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Alfredo Lucendo
- Gastroenterology Unit, Hospital de Tomelloso, Ciudad Real, Spain
| | | | | | - Oleg Shvets
- Gastroenterology Unit, Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine
| | - Galina Fadeenko
- Gastroenterology Unit, National Ukrainian Academy of Medical Sciences, Ukraine
| | - Jose M Huguet
- Gastroenterology Unit, Consorci Hospital General Universitari Valencia, Spain
| | - Zdenki Kikec
- Gastroenterology Unit, Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Dmitry Bordin
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Irina Voynovan
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Marcis Leja
- Gastroenterology Unit, Digestive Diseases Center GASTRO, Riga, Latvia
| | - Jose Carlos Machado
- Gastroenterology Unit, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, and Ipatimup-Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | - Miguel Areia
- Gastroenterology Unit, Portuguese Oncology Institute of Coimbra, Portugal
| | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sergey Alekseenko
- Gastroenterology Unit, Far Eastern State Medical University Khabarovsk, Russia
| | - Jesus Barrio
- Gastroenterology Unit, Hospital Rio Hortega, Valladolid, Spain
| | - Juan Ortuño
- Gastroenterology Unit, Hospital Universitari I Politècnic La Fe Valencia, Spain
| | - Monica Perona
- Gastroenterology Unit, Hospital Quiron Marbella, Spain
| | | | - Pilar Mata Romero
- Gastroenterology Unit, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Oleg Zaytsev
- Gastroenterology Unit, First Clinical Medical Center Kovrov, Russia
| | - Theodore Rokkas
- Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- Gastroenterology Unit, Athens Medical Center, Paleo Faliron General Hospital Athens, Greece
| | | | - Gyorgy M Buzas
- Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary
| | - Ines Modolell
- Gastroenterology Unit, Consorci Sanitari Terrassa, Spain
| | | | - Ilkay Simsek
- Gastroenterology Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Cem Simsek
- Gastroenterology Unit, Hacettepe University Ankara, Turkey
| | | | | | | | | | | | | | - Perminder Phull
- Gastroenterology Unit, Aberdeen Royal Infirmary Aberdeen, United Kingdom
| | - Oscar Nuñez
- Gastroenterology Unit, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Frode Lerang
- Gastroenterology Unit, Medical Department, Central Hospital Ostfold, Fredrikstad, Norway
| | - Marino Venerito
- Gastroenterology Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Frederic Heluwaert
- Gastroenterology Unit, Center Hospitalier Annecy Genvois, Pringy, France
| | - Ante Tonkic
- Gastroenterology Unit, University Hospital of Split, School of Medicine, University of Split, Croatia
| | - Maria Caldas
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ignasi Puig
- Gastroenterology Unit, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Francis Megraud
- Gastroenterology Unit, Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux, France
| | - Colm O'Morain
- Gastroenterology Unit, Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Abstract
Introduction: Eradication of Helicobacter pylori (H. pylori) becomes more challenging due to increasing antimicrobial resistance. Consequently, the performance of clarithromycin-containing triple therapies is now declining to unacceptable levels and should be abandoned unless a prior susceptibility test precludes clarithromycin resistance.Areas covered: This review summarizes updated evidence concerning new and advancing pharmacotherapy options for H. pylori eradication.Expert opinion: Due to the declining efficacy of legacy triple therapies, most guidelines recommend bismuth quadruple therapy as the best initial empiric treatment. Concomitant, sequential and hybrid therapies are remarkable bismuth-free quadruple options, provided that dual clarithromycin-metronidazole resistance is low. Levofloxacin-, rifabutin-, furazolidone- and sitafloxacin-containing regimens remain useful, particularly as salvage options. To eradicate H. pylori in line with the rules of antibiotic stewardship, susceptibility-guided treatment appears as the ideal approach. However, the feasibility and cost-effectiveness of universal pre-treatment susceptibility testing warrants further evaluation. Molecular testing methods promise convenient characterization of H. pylori antibiotic susceptibility. High-dose dual therapy (proton-pump-inhibitor plus amoxicillin) and vonoprazan, a more potent acid inhibitor that likely enhances the activity of amoxicillin, are promising alternatives that could decrease misuse of antibiotics. Addition of certain probiotics could somewhat increase the performance of H. pylori eradication regimens, while improving tolerability.
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Affiliation(s)
- Sotirios Georgopoulos
- Department of Gastroenterology, Athens Medical P. Faliron General Hospital, Athens, Greece
| | - Vasilios Papastergiou
- Department of Gastroenterology, "Konstantopoulion-Patision" General Hospital, Athens, Greece
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11
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Papoutsis K, Kapelouzou A, Georgiopoulos G, Kontogiannis C, Kourek C, Mylonas KS, Patelis N, Cokkinos DV, Karavokyros I, Georgopoulos S. Tissue-specific relaxin-2 is differentially associated with the presence/size of an arterial aneurysm and the severity of atherosclerotic disease in humans. Acta Pharmacol Sin 2020; 41:745-752. [PMID: 32024951 PMCID: PMC7471450 DOI: 10.1038/s41401-019-0350-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/12/2019] [Indexed: 12/31/2022] Open
Abstract
Circulating or tissue-related biomarkers are of clinical value for risk stratification in patients with abdominal aortic aneurysms. Relaxin-2 (RL2) has been linked to the presence and size of arterial aneurysms, and to the extent of atherosclerosis in human subjects. Here, we assessed the expression levels of RL2 in aneurysmal (AA, n = 16) and atherosclerotic (ATH, n = 22) arteries, and established the correlation between RL2 levels and the presence/size of AA and the clinical severity of atherosclerosis. The expression levels of metalloproteinases (MMPs) and endothelial nitric oxide synthetase (eNOS) were also detected for correlations with different phenotypes of atherosclerosis and AA. Temporal artery biopsy specimens (n = 6) and abdominal aortic tissues harvested from accident victims during autopsy (n = 10) were used as controls. Quantitative tissue biomarker analysis revealed that tissue-specific RL2 was increased in patients with larger or symptomatic AA compared to subjects with atherosclerotic disease and healthy controls. In situ RL2 levels were proportional to the size and the severity of aneurysmatic disease, and were substantially elevated in patients with symptomatic aneurysm of any diameter or asymptomatic aneurysm of a diameter >350% of that of the normal artery. In contrast, tissue RL2 was inversely associated with the clinical severity of atherosclerotic lesions. Correlation between RL2 and MMP2 was different between ATH1 and ATH2, depending on atherosclerosis grade. Overall, tissue RL2 is differentially associated with discrete phenotypes of arterial disease and might exert multipotent biological effects on vascular wall integrity and remodeling in human subjects.
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12
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Doulberis M, Papaefthymiou A, Polyzos SA, Boziki M, Deretzi G, Giartza-Taxidou E, Vardaka E, Grigoriadis N, Katsinelos T, Touloumtzi M, Papanikopoulou K, Anastasiadou K, Georgopoulos S, Dardiotis E, Anastasiadis S, Katsinelos P, Kountouras J. Microbes and Alzheimer' disease: lessons from H. pylori and GUT microbiota. Eur Rev Med Pharmacol Sci 2020; 23:1845-1846. [PMID: 30915725 DOI: 10.26355/eurrev_201903_17218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Doulberis
- Department of General Internal Medicine, University Hospital Inselspital Bern, Bern, Switzerland. ;
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13
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Karamichalakis N, Ikonomidis I, Parissis J, Simitsis P, Xydonas S, Letsas K, Manolatos D, Vlachos K, Georgopoulos S, Efremidis M, Sideris A, Filippatos G. 414 Ventricular-arterial interaction predicts response to cardiac resynchronization therapy: a link with improvement of endothelial function and arterial elastic properties. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Endothelial dysfunction (ED) is a hall mark of chronic heart failure and has been linked to disease progression, hospitalizations and mortality.
Purpose
to evaluate the impact of cardiac resynchronization therapy (CRT) in ED and to determine predictors of response to CRT
Methods
CRT recipients from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns.
Results
32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction were enrolled. During follow-up, LVEF, GLS, LVESV and all ED markers exhibited significant improvement (table 1). 23 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p = 0.044).Threshold analysis showed that the best threshold of cfPWV/GLS for response to CRT was 2.75 (specificity: 0.67%, sensitivity: 0.94%).
Conclusions
After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction are improved. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT.
table 1 Baseline Follow-up Change Measurement mean (sd) mean (sd) mean (sd) p-value SBP (mmHg) 126 (19) 128 (16) 2.18 (11.98) 0,465 DBP (mmHg) 79 (9) 80 (9) 1.06 (8.58) 0,618 LVEF (%) 27 (7) 35 (9) 7.50 (4.77) <0.001 LVESV (mL) 151 (42) 120 (46) -26.91 (17.20) <0.001 GLS (%) 6.47 (2.89) 9.33 (4.18) 2.85 (2.28) <0.001 FMD (%) 5.88 (2.79) 10.25 (3.67) 4.37 (3.34) <0.001 Ea/Ees 2.81 (1.10) 2.04 (0.99) -0.77 (0.47) <0.001 cfPWV 11.11 (2.61) 10.01 (2.45) -1.10 (1.56) 0,003 PBR 5-25(microns) 2.26 (0.20) 2.14 (0.24) -0.13 (0.25) 0,028 cfPWV/GLS 2.18 (1.46) 1.45 (1.11) -0.73 (0.55) <0.001 Measurements at baseline, follow-up and their change during study
Abstract 414 Figure. picture 1
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Affiliation(s)
- N Karamichalakis
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - I Ikonomidis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - J Parissis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - P Simitsis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - S Xydonas
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - D Manolatos
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - K Vlachos
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - G Filippatos
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
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14
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Patelis N, Doulaptsis M, Kykalos S, Spartalis E, Maskanakis A, Georgopoulos S. Physiology of Intraluminal Administration of Carbon Dioxide as a Contrast Medium. Curr Pharm Des 2019; 25:4656-4661. [PMID: 31814550 DOI: 10.2174/1381612825666191209124911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/19/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Carbon dioxide (CO2) exists in nature around us. In the middle of the 20th century, the intraluminal injection of CO2 demonstrated similar results to those of Digital Subtraction Angiography (DSA) with an iodinated contrast agent (ICA). Since then, the technology behind CO2 DSA has developed significantly. OBJECTIVE The aim of this study is to inform physicians about the unique properties of CO2 and its physiology after intraluminal injection. METHODS An extensive search for English literature on the properties of CO2 and the physiology of intraluminal administration was conducted using Pubmed. RESULTS There is sufficient literature on the properties of CO2 and the physiology of CO2 DSA. A review of this literature explains what happens to the human organism after the injection of CO2. CONCLUSION There is enough evidence that CO2 DSA is both effective, diagnostic and safe, but the properties of CO2 should be taken under consideration as complications occur, although rarely.
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Affiliation(s)
| | - Mikes Doulaptsis
- Department of Vascular Surgery, General Hospital Georgios Gennimatas, Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propaedeutic Surgery, Laiko General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Maskanakis
- Vascular Surgery Department, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Sotirios Georgopoulos
- Vascular Unit, First Department of Surgery, Laiko General Hospital, National & Kapodistrian University of Athens, Athens, Greece
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15
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Patelis N, Kakavia K, Maltezos K, Damaskos C, Spartalis E, Matheiken S, Georgopoulos S. An Update on Novel Antiplatelets in Vascular Patients. Curr Pharm Des 2019; 24:4558-4563. [PMID: 30585537 DOI: 10.2174/1381612825666181226144129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acetylsalicylic acid, clopidogrel and cilostazol are well-established agents inhibiting the normal function of platelets with known advantages and limitations. The development of novel antiplatelet agents aims to provide equal or superior outcomes for patients and simultaneously minimize side effects. OBJECTIVE The aim of this manuscript is to review the latest data on the use of novel antiplatelet agents in vascular patients. METHOD Based on our 2016 review, a further search in the English medical literature has yielded a number of publications on cangrelor, prasugrel, ticagrelor, vorapaxar and a number of other - still experimental - agents (Ir- 6, UBO-QIC, W1, revacept and YM-254890). RESULTS Recently published data have not altered the use and indications of cangrelor, prasugrel and vorapaxar; all of them now approved by both FDA and EMA. The EUCLID trial has recently provided valuable data on the clinical use of ticagrelor, although results regarding vascular patients and administration of ticagrelor are still under scrutiny. Vorapaxar remains the only novel antiplatelet that is approved for PAD. Randomized control trials that focus on vascular patients are necessary to establish the safety and efficacy of these novel agents. Despite their positive initial results, most novel experimental antiplatelets are still in early development, thus in preclinical or early clinical phases of their trials. Research on three novel antiplatelets is currently discontinued (atopaxar, darexaban and elinogrel). CONCLUSION Vorapaxar remains the only novel antiplatelet that is approved for PAD. Other novel antiplatelets demonstrate positive results, but further studies focused on vascular patients are necessary. Novel experimental antiplatelets are still in the early phases of the clinical and preclinical studies.
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Affiliation(s)
- Nikolaos Patelis
- Vascular Unit, First Department of Surgery, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Kyriaki Kakavia
- Vascular Unit, First Department of Surgery, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Konstantinos Maltezos
- Vascular Unit, First Department of Surgery, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sean Matheiken
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Foundation Trust, BB2 3HQ, United Kingdom
| | - Sotirios Georgopoulos
- Vascular Unit, First Department of Surgery, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Dodos I, Georgopoulos S, Dodos K, Konstantakopoulou O, Grammatoglou X, Dervisis K, Bakoyiannis C, Klonaris C. Correlation of Glycosylated Hemoglobin Levels with Histological and Ultrasound Characteristics of the Carotid Plaque in Diabetic and Nondiabetic Patients. Ann Vasc Surg 2019; 61:218-226. [PMID: 31344464 DOI: 10.1016/j.avsg.2019.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the correlation of glycosylated hemoglobin (HbA1c) levels with histological characters of atherosclerotic plaque that makes it vulnerable, as well as ultrasound (US) criteria that can contribute to the prognosis of carotid disease. MATERIAL AND METHODS This is a single-center prospective study. Our study population consists of 74 diabetic and nondiabetic patients with carotid atherosclerosis who underwent carotid endarterectomy in our department. Patient categorization was based on the following criteria: levels of HbA1c, gender, and risk factors (smoking, hypertension), carotid stenosis rate, symptomatic or asymptomatic carotid disease, histological examination of the atherosclerotic plaque, and US morphological criteria of the plaque. RESULTS The mean age of the patients was 68.2 years (standard deviation = 7.8); 58.1% were smokers, 71.6% had arterial hypertension, 37.8% had symptomatic carotid disease, and 64.9% had atherosclerotic plaque type 6. Futhermore, 95.9% of the patients had a carotid stenosis rate more than 70% and 4.1% had from 50% to 69%. Older patients had more frequent type 7 and 8 atherosclerotic plaque based on American Heart Association scoring system than younger patients (P = 0.041). The relative likelihood of atherosclerotic plaque type 7 and 8 was 1.12 times higher in older patients (Odds ratio [OR] = 1.12, P = 0.029). Patients with higher levels of HbA1cwere more likely to have type 6 atherosclerotic plaque than those with atherosclerotic lesions type 7 and 8 (P < 0.001). Specifically, increasing the level of HbA1c by 1 mg/dl increases the likelihood of the presence of vulnerable plaque by 2.55%. Moreover, the relative likelihood of a type 6 atherosclerotic plaque was 10.4 times higher in the older patients (OR = 10.4, P < 0.001). CONCLUSIONS This study demonstrates that levels of HbA1c and advanced age are 2 factors that may be correlated with the presence of vulnerable carotid plaques in diabetic population. Moreover, HbA1c is an independent factor that could possibly be used as a prognostic marker for carotid artery disease, although further studies are needed to explore this association to elucidate the precise role of HbA1c.
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Affiliation(s)
- Ilias Dodos
- General Hospital Konstantopouleio, Vascular Surgery Department, Athens, Attica, Greece.
| | - Sotirios Georgopoulos
- General Hospital of Athens Laiko, 1st Surgical Department, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Konstantinos Dodos
- General Hospital of Kifisia Agioi Anargyroi, Internal Medicine Department, Athens, Attica, Greece
| | | | | | - Konstantinos Dervisis
- General Hospital Konstantopouleio, Vascular Surgery Department, Athens, Attica, Greece
| | - Christos Bakoyiannis
- General Hospital of Athens Laiko, 1st Surgical Department, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Christos Klonaris
- General Hospital of Athens Laiko, 1st Surgical Department, National and Kapodistrian University of Athens, Athens, Attica, Greece
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17
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Dimopoulos C, Damaskos C, Papadakis M, Garmpis N, Kontzoglou K, Perrea D, Moraitis S, Daskalopoulou A, Papaspirou I, Georgopoulos S, Nikiteas N. Expression of S100B Protein in Ischemia/Reperfusion-Induced Brain Injury After Cyclosporine Therapy: A Biochemical Serum Marker with Prognostic Value? Med Sci Monit 2019; 25:1637-1644. [PMID: 30826814 PMCID: PMC6410611 DOI: 10.12659/msm.912810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Accumulating evidence has indicated that S100B protein may be involved in the pathophysiology of ischemia-reperfusion brain injury. Cyclosporine has been shown to have neuroprotective functions. This study investigated the effect of cyclosporine on S100B serum levels and the severity of brain tissue damage in a rat model of cerebral ischemia-reperfusion (I/R). Material/Methods Twelve-week-old Wistar male rats were randomly divided into Control I/R and Cyclosporine I/R groups (n=10 each). Cyclosporine was given orally by gavage for 5 days prior to cerebral I/R, at a total volume of 15 mg/kg/day. The Control group received an equal volume of saline. Body weight was measured and all animals were subjected to 60-min focal ischemia by filament occlusion of the middle cerebral artery. ELISA was used to assess the concentrations of serum S100B and development of brain infarct size and neurological outcomes were determined at 2 and 24 h after occlusion withdrawal. Results Cyclosporine improved the neurological deficit score and decreased the cerebral infarct size and body weight. S100B serum levels were significantly elevated in Cyclosporine-treated rats compared with untreated Control rats during the reperfusion phase. Total infarct size was positively associated with S100B serum levels in the Control I/R group, but no significant correlation was observed in the Cyclosporine I/R group. Conclusions Cyclosporine seems to affect both ischemia-reperfusion brain tissue damage and S100B protein serum levels. S100B serum level appears to be a state marker for the severity of the cerebral ischemia-reperfusion, rather than a trait marker for Cyclosporine responsiveness.
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Affiliation(s)
- Christos Dimopoulos
- Laboratory for Experimental Surgery and Surgical Research "N.S. Christeas", Medical School of Athens, Athens, Greece.,Department of Vascular and Endovascular Surgery, Heinrich-Heine-University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Christos Damaskos
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Medical School of Athens, Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Papadakis
- Department of Plastic Surgery, Helios Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Perrea
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Medical School of Athens, Athens, Greece
| | - Stavros Moraitis
- Department of Pathology, Alexandra Hospital Athens, Athens, Greece
| | - Afroditi Daskalopoulou
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Medical School of Athens, Athens, Greece
| | - Irini Papaspirou
- Department of Pathology, Alexandra Hospital Athens, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Vascular Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Medical School of Athens, Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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18
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Patelis ND, Malli A, Mylonas KS, Schizas D, Papa N, Economopoulos KP, Damaskos C, Moulakakis K, Katsargyris A, Georgopoulos S, Klonaris C, Liakakos T. Suitability study of current endovascular aortic repair devices based on real-life anatomic data. Expert Rev Med Devices 2018; 16:165-171. [DOI: 10.1080/17434440.2019.1561268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nikolaos D. Patelis
- First Department of Surgery, Vascular Unit, National & Kapodistrian Universtiy of Athens, Athens, Greece
| | - Antonia Malli
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Dimitrios Schizas
- First Department of Surgery, Vascular Unit, National & Kapodistrian Universtiy of Athens, Athens, Greece
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Nektario Papa
- First Department of Surgery, Vascular Unit, National & Kapodistrian Universtiy of Athens, Athens, Greece
| | | | - Christos Damaskos
- Laboratory for Experimental Surgery and Surgical Research “N. S. Christeas”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Moulakakis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Sotirios Georgopoulos
- First Department of Surgery, Vascular Unit, National & Kapodistrian Universtiy of Athens, Athens, Greece
| | - Chris Klonaris
- First Department of Surgery, Vascular Unit, National & Kapodistrian Universtiy of Athens, Athens, Greece
| | - Theodoros Liakakos
- First Department of Surgery, Vascular Unit, National & Kapodistrian Universtiy of Athens, Athens, Greece
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19
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Papoutsis K, Kapelouzou A, Tsilimigras DI, Patelis N, Kouvelos G, Schizas D, Karavokyros I, Georgopoulos S. Associations between serum relaxin 2, aneurysm formation/size and severity of atherosclerosis: a preliminary prospective analysis. Acta Pharmacol Sin 2018; 39:1243-1248. [PMID: 29565035 DOI: 10.1038/aps.2018.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/07/2018] [Indexed: 12/20/2022] Open
Abstract
Serum relaxin 2 (RL2) is a pleiotropic hormone that acts on various organs and systems, particularly the cardiovascular system. Although RL2 seems to upregulate the synthesis of nitric monoxide (NO) and matrix metalloproteinase (MMP)-2 and -9, current literature on its role in atherosclerosis and aneurysm formation is scarce. The aim of this study was to investigate the levels of serum RL2 in patients with an arterial aneurysm as well as in atherosclerotic patients, and correlate them with the severity of their related vascular disease. A total of 53 subjects were enrolled in this study: 37 patients were scheduled to undergo surgery: 21 patients for different forms of atherosclerotic disease (ATH), 16 patients for an arterial aneurysm (AA), 6 patients for undergoing temporal artery biopsy (TAB), and 10 healthy blood donors (HBD) served as the control groups. RL2 was measured using enzymelinked immunosorbent assay. RL2 was significantly higher in AA patients compared to ATH (P<0.01), TAB (P<0.001) and HBD (P<0.01). No significant difference was found between the ATH and TAB groups (P>0.05). In addition, ATH and AA patients were further subdivided based on the severity of their disease. Serum RL2 was progressively increased in patients with arterial aneurysms, showing a positive relationship with the size of the aneurysmatic dilatation. By contrast, the RL2 level was inversely related to the severity of the atherosclerotic disease. Studies with a larger cohort incorporating a consistent study population are warranted to verify our results and shed light on the mechanistic background of these processes.
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20
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Maskanakis A, Patelis N, Karaolanis G, Davakis S, Schizas D, Perrea D, Klonaris C, Georgopoulos S, Liakakos T, Bakoyiannis C. Apolipoprotein J as a predictive biomarker for restenosis after carotid endarterectomy: a retrospective study. Acta Pharmacol Sin 2018; 39:1237-1242. [PMID: 29417939 DOI: 10.1038/aps.2017.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/31/2017] [Indexed: 12/22/2022] Open
Abstract
Carotid endarterectomy (CEA) is an effective surgical option for stroke prophylaxis in most patients. Restenosis after CEA can lead to re-intervention and adverse events, but the factors predicting restenosis are poorly understood. Apolipoprotein J (ApoJ) is considered to be a novel predictive factor of vascular restenosis and is associated with a large number of processes related to atherosclerosis and cell-cycle phases. The aim of this study was to elucidate the predictive value of Apo J in internal carotid artery (ICA) restenosis following CEA. This retrospective study examined all prospectively collected data for patients who underwent CEA at our surgical department over a 2-year period. The serum ApoJ levels of 100 patients were examined; 56 patients who underwent CEA comprised the vascular group (VG), and 44 patients who underwent minor surgery comprised the control group (CG). ApoJ samples were obtained preoperatively, 24 h after the surgical procedure and at 1, 6 and 12 months thereafter during the follow-up. The preoperative difference in ApoJ levels between the CG and VG was statistically signifcant; the mean values were 39.11±14.16 and 83.03±35.35 μg/mL, respectively. In the VG, the serum ApoJ levels were 112.09±54.40, 71.20±23.70, 69.92±25.76 and 62.25±19.17 μg/mL at postoperative day 1 and at 1, 6 and 12 months post-operatively, respectively, while the ApoJ concentrations of patients in the CG remained unchanged. Further subdivision of the VG into patients with or without restenosis revealed that restenosis patients presented signifcantly higher mean ApoJ values than non-restenosis VG patients. In summary, ApoJ seems to be an important predictor for carotid restenosis at 6 and 12 months postoperatively.
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21
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Vlachos K, Letsas K, Asvestas D, Bazoukis G, Saplaouras A, Martin R, Kalafateli M, Lioni L, Georgopoulos S, Karamichalakis N, Sakellaropoulou A, Kolokathis AM, Valkanas K, Sideris A, Efremidis M. P931Low voltage areas detected by high-density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.532] [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: 11/13/2022] Open
Affiliation(s)
- K Vlachos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - D Asvestas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - G Bazoukis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Saplaouras
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - R Martin
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - M Kalafateli
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - L Lioni
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - N Karamichalakis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Sakellaropoulou
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A M Kolokathis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Valkanas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
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22
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Vlachos K, Letsas K, Saplaouras A, Bazoukis G, Asvestas D, Giannakakis G, Martin R, Sakellaropoulou A, Kolokathis AM, Valkanas K, Georgopoulos S, Karamichalakis N, Geladari E, Efremidis M, Sideris A. P1174Targeted ablation of specific electrogram patterns in low voltage areas after pulmonary vein antral isolation in persistent AF: termination to an organized rhythm reduces AF recurrence. Europace 2018. [DOI: 10.1093/europace/euy015.659] [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: 11/13/2022] Open
Affiliation(s)
- K Vlachos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Saplaouras
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - G Bazoukis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - D Asvestas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - G Giannakakis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - R Martin
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A Sakellaropoulou
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A M Kolokathis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - K Valkanas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - N Karamichalakis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - E Geladari
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Athens, Greece
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23
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Asvestas D, Letsas K, Bazoukis G, Saplaouras A, Goga C, Sakellaropoulou A, Vlachos K, Georgopoulos S, Sideris A, Efremidis M. P828Quantitative assessment of left atrial fibrosis in patients with paroxysmal atrial fibrillation using high density Confidense mapping. Europace 2018. [DOI: 10.1093/europace/euy015.432] [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: 11/14/2022] Open
Affiliation(s)
- D Asvestas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - G Bazoukis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Saplaouras
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - C Goga
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Sakellaropoulou
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - K Vlachos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Athens, Greece
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24
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Letsas KP, Xydonas S, Karamichalakis N, Efremidis M, Manolatos D, Bazoukis G, Asvestas D, Vlachos K, Georgopoulos S, Saplaouras A, Winter J, Sideris A. Intermuscular implantation technique for subcutaneous cardioverter-defibrillators. Herz 2018; 44:541-545. [PMID: 29468258 DOI: 10.1007/s00059-018-4688-0] [Citation(s) in RCA: 3] [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] [Received: 11/02/2017] [Revised: 01/19/2018] [Accepted: 01/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The conventional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation has been associated with pocket complications. The aim of this study was to evaluate the efficacy and safety of an alternative intermuscular technique for S‑ICD implantation. METHODS S-ICDs were implanted in ten consecutive patients (ten males, mean age: 46.8 ± 14.7 years). The pocket for the pulse generator was made above the serratus anterior muscular fascia and beneath the latissimus dorsi muscle by detaching the fibrous tissue between the muscles. Electrode implantation was performed using the three- (n = 4) or the two-incision technique (n = 6). RESULTS All S‑ICDs were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, apart from one patient with Brugada syndrome who needed device repositioning more dorsally. During a mean follow-up of 16.5 ± 7.3 months, no major complications requiring surgical repair were encountered, while patients demonstrated high levels of comfort and satisfaction with the cosmetic result. One patient experienced an inappropriate shock due to noise detection, which was resolved after reprogramming to a different sensing vector. CONCLUSION The intermuscular technique is a safe and efficacious approach for S‑ICD implantation. This technique could lead to fewer pocket-related complications and better cosmetic results.
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Affiliation(s)
- K P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - S Xydonas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - N Karamichalakis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - M Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - D Manolatos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - G Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece.
| | - D Asvestas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - K Vlachos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - S Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - A Saplaouras
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - J Winter
- Division of Cardiac Surgery, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - A Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
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25
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Karaolanis G, Moris D, McCoy CC, Tsilimigras DI, Georgopoulos S, Bakoyiannis C. Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma. Front Surg 2018; 5:7. [PMID: 29516005 PMCID: PMC5826055 DOI: 10.3389/fsurg.2018.00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/30/2017] [Accepted: 01/29/2018] [Indexed: 12/17/2022] Open
Abstract
The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.
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Affiliation(s)
- Georgios Karaolanis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - C. Cameron McCoy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Diamantis I. Tsilimigras
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Bakoyiannis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
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26
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Moris D, Spartalis M, Georgopoulos S. Letter by Moris et al Regarding Article, "One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis". Stroke 2018; 49:e129. [PMID: 29438079 DOI: 10.1161/strokeaha.117.019762] [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: 12/07/2022]
Affiliation(s)
| | - Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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27
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Moris D, Theocharis S, Davakis S, Patelis N, Agrogiannis G, Vlachos IS, Spartalis E, Athanasiou A, Bakoyiannis C, Perrea DN, Georgopoulos S. Serum Calprotectin as a Novel Biomarker in Abdominal Aortic Aneurysm Pathogenesis and Progression: Preliminary Data from Experimental Model in Rats. Curr Vasc Pharmacol 2018; 16:168-178. [DOI: 10.2174/1570161115666170202155724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Demetrios Moris
- 1st Department of Surgery, "Laikon" General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Theocharis
- Department of Pathology, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Davakis
- 1st Department of Surgery, "Laikon" General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Patelis
- 1st Department of Surgery, "Laikon" General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Agrogiannis
- Department of Pathology, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis S. Vlachos
- Laboratory for Experimental Surgery and Surgical Research “N.S. Christeas”, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory for Experimental Surgery and Surgical Research “N.S. Christeas”, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Athanasiou
- 1st Department of Surgery, "Laikon" General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Bakoyiannis
- 1st Department of Surgery, "Laikon" General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina N. Perrea
- Laboratory for Experimental Surgery and Surgical Research “N.S. Christeas”, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, "Laikon" General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
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28
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Pikoulis E, Salem KM, Avgerinos ED, Pikouli A, Angelou A, Pikoulis A, Georgopoulos S, Karavokyros I. Damage Control for Vascular Trauma from the Prehospital to the Operating Room Setting. Front Surg 2017; 4:73. [PMID: 29312951 PMCID: PMC5742177 DOI: 10.3389/fsurg.2017.00073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/20/2017] [Indexed: 01/12/2023] Open
Abstract
Early management of vascular injury, starting at the field, is imperative for survival no less than any operative maneuver. Contemporary prehospital management of vascular trauma, including appropriate fluid and volume infusion, tourniquets, and hemostatic agents, has reversed the historically known limb hemorrhage as a leading cause of death. In this context, damage control (DC) surgery has evolved to DC resuscitation (DCR) as an overarching concept that draws together preoperative and operative interventions aiming at rapidly reducing bleeding from vascular disruption, optimizing oxygenation, and clinical outcomes. This review addresses contemporary DCR techniques from the prehospital to the surgical setting, focusing on civilian vascular injuries.
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Affiliation(s)
- Emmanouil Pikoulis
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anastasia Pikouli
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Anastasios Angelou
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Antreas Pikoulis
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Ioannis Karavokyros
- 1st Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
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29
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Karaolanis G, Moris D, Bakoyiannis C, Tsilimigras DI, Palla VV, Spartalis E, Schizas D, Georgopoulos S. A critical reappraisal of the treatment modalities of normal appearing thoracic aorta mural thrombi. Ann Transl Med 2017; 5:306. [PMID: 28856146 DOI: 10.21037/atm.2017.05.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mural thrombus in non-atherosclerotic or aneurysmatic thoracic aorta is a relatively uncommon entity. Currently there is no consensus on the appropriate therapeutic algorithm of its management. We aim to present the current knowledge on the treatment of thoracic aorta mural thrombi (TAMT) in minimally atherosclerotic vessels and we hope that the juxtaposed discussions will shed light on the uncharted waters regarding this rare syndrome. The MEDLINE/PubMed database was searched for publications with the medical subject "aortic mural thrombus" and keywords "thoracic", "embolism", "normal vessel", "minimally atherosclerotic vessel" or "treatment". We restricted our search to English language, till January 2017. The electronic literature search yielded 23 reports that were deemed appropriate for further analysis. Anticoagulation is the standard of care for the treatment of the thrombus whereas surgical and interventional treatment seems to be related with increased mortality and lower recurrence rates. TAMT treatment is controversial. Anticoagulants are the mainstay of treatment but surgery seems to gain ground in several settings as an only therapy or a combined treatment modality. More data are needed on the role of novel oral anticoagulants and endografts.
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Affiliation(s)
- Georgios Karaolanis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chris Bakoyiannis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Viktoria-Varvara Palla
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Eleftherios Spartalis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
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30
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Kasapidis P, Bassioukas S, Mavrogenis G, Tribonias G, Delis K, Georgopoulos S, Christodoulou D, Emmanouil T, Paraskeva K, Panteris V, Papalois A, Triantafillidis J, Tsiamoulos Z, Fukuhara T, Komeda Y, Kashida H. Experimental gastric endoscopic submucosal dissection: training in a porcine model. Ann Gastroenterol 2017; 30:446-449. [PMID: 28655983 PMCID: PMC5479999 DOI: 10.20524/aog.2017.0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/05/2017] [Indexed: 12/18/2022] Open
Abstract
Background Endoscopic submucosal dissection (ESD) requires special skills and a long procedure time for a quality-controlled procedure. A universal training system remains to be established. Hands-on courses in animal models before advancing to the human colon appear to be essential, especially in Europe. The learning curve is a prerequisite in ESD, in order to improve technical outcomes and decrease the rate of procedural adverse events. Methods In the experimental research center of ELPEN Pharmaceuticals, 18 European endoscopists, inexperienced at ESD, performed gastric ESDs in porcine models. The course lasted two days and was conducted under the supervision of experts. Results A total of 72 of 76 ESDs were completed en bloc (94.7%). The procedural time and cutting speed differed significantly between the first and second day: 48±4.4 vs. 43±4.8 min (P=0.0045), and 1.38±0.20 vs. 1.63±0.23 cm2/min (P=0.0033), respectively. The complications were not significantly different between the two groups: five (13.88%) vs. four (11%) episodes of bleeding (P>0.05). The perforation rate was similar, at two episodes per day (5.55%). We documented an acceptable rate of en bloc resections and complications. Conclusion ESD demands a new level of endoscopic skills in Europe. A formal sequential training program, using porcine models, may benefit countries with a low volume of cases.
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Affiliation(s)
- Panagiotis Kasapidis
- Head, Department of Gastroenterology and Endoscopy Unit, Central Clinic, Athens, Greece (Panagiotis Kasapidis)
| | | | - Georgios Mavrogenis
- Department of Endoscopy, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis)
| | - Georgios Tribonias
- Department of Endoscopy, Eugenideio Hospital, Athens, Greece (Georgios Tribonias)
| | - Konstantinos Delis
- Department of Gastroenterology, Metropolitan Hospital, Piraeus, Greece (Konstantinos Delis)
| | - Sotirios Georgopoulos
- Department of Gastroenterology and Endoscopy Unit, Athens Medical Center, Faliron, Athens, Greece (Sotirios Georgopoulos)
| | - Dimitrios Christodoulou
- Gastroenterology Department, University of Ioannina, School of Medicine, Ioannina, Greece (Dimitrios Christodoulou)
| | | | - Konstantina Paraskeva
- Department of Gastroenterology, Konstantopoulion General Hospital, Athens, Greece (Konstantina Paraskeva)
| | | | | | | | - Zacharias Tsiamoulos
- GI Endoscopy East Kent University Hospitals Trust Senior Clinical Researcher, Imperial College, London St Mark's Hospital/Academic Institute, United Kingdom (Zacharias Tsiamoulos)
| | - Takataro Fukuhara
- Department of Molecular Genetics, Institute for Biomedical Science, Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan (Takataro Fukuhara)
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Ohno-Higashi, Osaka-Sayama, Osaka, Japan, Faculty of Medicine, Kindai University (Yoriaki Komeda, Hiroshi Kashida)
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Ohno-Higashi, Osaka-Sayama, Osaka, Japan, Faculty of Medicine, Kindai University (Yoriaki Komeda, Hiroshi Kashida)
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Dilaveris P, Gatzoulis K, Georgopoulos S, Antoniou CK, Anastasakis A, Theopistou A, Sideris S, Tsiachris D, Arsenos P, Tousoulis D. P944Prospective study of implantable cardioverter-defibrillator activation in hypertrophic cardiomyopathy patients in greece. Europace 2017. [DOI: 10.1093/ehjci/eux151.126] [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: 11/13/2022] Open
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Bazoukis G, Letsas KP, Vlachos K, Asvestas D, Saplaouras A, Karamichalakis N, Georgopoulos S, Lioni L, Kolokathis A, Sakellaropoulou A, Sideris A, Efremidis M. P368New oral anticoagulants compared to acenocoumarol for perioperative anticoagulation in patients undergoing atrial fibrillation catheter ablation. Europace 2017. [DOI: 10.1093/ehjci/eux141.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Antoniou CK, Gatzoulis K, Georgopoulos S, Anastasakis A, Theopistou A, Sideris S, Dilaveris P, Arsenos P, Tsiachris D, Tousoulis D. 649Reappraisal of the value of electrophysiological study in sudden cardiac death risk stratification in hypertrophic cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux145] [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: 11/13/2022] Open
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Douvas I, Moris D, Karaolanis G, Bakoyiannis C, Georgopoulos S. Evaluation of cerebrovascular reserve capacity in symptomatic and asymptomatic internal carotid stenosis with transcranial Doppler. Physiol Res 2016; 65:917-925. [PMID: 27539111 DOI: 10.33549/physiolres.933303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cerebrovascular reserve capacity (CVRC) is a hemodynamic parameter indicating the brain's capacity to overcome ischemia. Transcranial Doppler (TCD) is a useful device to measure CVRC, with high availability and low cost. The aim of the study is to investigate asymptomatic patients with affected CVRC, who could benefit from CEA. One hundred and forty five consecutive patients (60 symptomatic and 65 asymptomatic), with internal carotid artery (ICA) stenosis >70 % and 20 healthy individuals without internal carotid stenosis underwent TCD-inhalation CO(2) tests in order to measure the CVRC in both hemispheres of each patient. CVRC between asymptomatic and symptomatic patients were significantly different in the 95 % confidence interval (CI) as well as the mean CVRC value in contralateral carotid artery. The correlation between CVRC in the carotid artery with stenosis and the existence of symptoms is significant at the 0.01 level. Additionally, symptoms and CVRC of the contralateral carotid artery are also significant at the 0.05 level and CVRC values in asymptomatic patients and the control group at the 0.01 level. None of the covariant factors, except the age, are significantly correlated with CRVC. CVRC could be an early mark-index to evaluate the risk of stroke in this group of patients and to design their therapeutic approach.
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Affiliation(s)
- I Douvas
- First Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, School of Medicine, Athens, Greece.
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35
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Bakoyiannis C, Moris D, Karaolanis G, Patelis N, Schizas D, Georgopoulos S, Liakakos T. Thoracic Aorta Aneurysm Repair in a Patient with a Solitary Kidney: Hybrid Surgery as a Bailout Procedure. Front Surg 2016; 3:62. [PMID: 27891504 PMCID: PMC5102893 DOI: 10.3389/fsurg.2016.00062] [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: 09/06/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) is an emerging treatment option for thoracic aorta aneurysms (TAA). Endovascular access is a challenge. We present a novel TEVAR technique in a patient with single kidney and a 6.4 cm TAA. Attempting to place a sheath through iliac arteries was unsuccessful. The decision to proceed to hybrid TEVAR was made. The protection of the solitary kidney was achieved through axillo-femoral bypass, followed by an end-to-side anastomosis between the aorta and a bifurcated graft. Through the graft, a stent was introduced in the thoracic aorta. With the use of contrast material, the right position of the graft was confirmed.
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Affiliation(s)
| | - Demetrios Moris
- Lerner Research Institute, Cleveland Clinic , Cleveland, OH , USA
| | | | - Nikolaos Patelis
- Department of Surgery, Laikon General Hospital , Athens , Greece
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Patelis N, Moris D, Schizas D, Georgopoulos S, Liakakos T. Going from Darkness to Gray Zones of Knowledge: The Role of Biomarkers on Major Adverse Cardiovascular Events after Carotid Interventions. Ann Vasc Surg 2016; 38:347-348. [PMID: 27664456 DOI: 10.1016/j.avsg.2016.09.001] [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: 09/01/2016] [Accepted: 09/15/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Nikolaos Patelis
- 1st Department of Surgery, Laikon General Hospital, Athens, Greece
| | - Demetrios Moris
- Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH.
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Bountouris I, Melas N, Karaolanis GI, Siafakas A, Bazinas T, Kouris N, Lagios K, Georgopoulos S, Perdikides T. Endovascular aneurysm repair with fascia suture technique: short and mid-term results. INT ANGIOL 2016; 35:504-509. [PMID: 26554442] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Percutaneous endovascular aneurysm repair (p-EVAR), has been widely spread based on the recent improvements in stent-graft technology and mainly in delivery system downsizing. Aim of this study is to investigate the safety and efficacy of fascia suture technique (FST) in p-EVAR during the short and mid-term follow-up (FU). METHODS Between April 2011 and July 2013, 64 consecutive patients with abdominal aortic aneurysm were enrolled in a prospective single center registry. Fifty-four patients were eligible for elective p-EVAR assisted by the fascia suture technique. Patients were prospectively followed with duplex scan 24 hours and 30 days postoperatively and with CTA annually thereafter. Femoral haematoma, pseudoaneurysm and limb ischaemia were the primary outcomes. RESULTS The study investigated 103 femoral arteries reconstructions using the FST. Intraoperatively, one patient was diagnosed with limb ischaemia treated with open repair. During the short-term, 4 (3.8%) pseudoaneurysms were diagnosed, treated with open (2) or endovascular (2) repair. During mid-term 43 patients (85 arteries, 82.6%) underwent CTA. Eighteen (17.4%) patients were lost at FU. At 12 months CTA two pseudoaneurysms (2.35%) were detected, treated with open repair. CONCLUSIONS The FST seems safe and effective for femoral reconstruction after p-EVAR. Complications are comparable to closure devices and to conventional repair.
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Affiliation(s)
- Ioannis Bountouris
- Department of Vascular Surgery Unit, 251 Hellenic Air Force Hospital, Athens, Greece -
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Klonaris C, Georgopoulos S, Katsargyris A. Endovascular treatment of the ascending aorta: new frontiers for thoracic endovascular aneurysm repair? J Thorac Dis 2016; 8:1901-3. [PMID: 27618954 DOI: 10.21037/jtd.2016.07.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chris Klonaris
- 1st Department of Surgery, Vascular Division, LAIKO Hospital, Athens University Medical School, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Vascular Division, LAIKO Hospital, Athens University Medical School, Athens, Greece
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
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Filis K, Toufektzian L, Galyfos G, Sigala F, Kourkoveli P, Georgopoulos S, Vavuranakis M, Vrachatis D, Zografos G. Assessment of the vulnerable carotid atherosclerotic plaque using contrast-enhanced ultrasonography. Vascular 2016; 25:316-325. [PMID: 27580821 DOI: 10.1177/1708538116665734] [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: 11/17/2022]
Abstract
Carotid atherosclerosis represents a primary cause for cerebrovascular ischemic events and its contemporary management includes surgical revascularization for moderate to severe symptomatic stenoses. However, the role of invasive therapy seems to be questioned lately for asymptomatic cases. Numerous reports have suggested that the presence of neovessels within the atherosclerotic plaque remains a significant vulnerability factor and over the last decade imaging modalities have been used to identify intraplaque neovascularization in an attempt to risk-stratify patients and offer management guidance. Contrast-enhanced ultrasonography of the carotid artery is a relatively novel diagnostic tool that exploits resonated ultrasound waves from circulating microbubbles. This property permits vascular visualization by producing superior angiography-like images, and allows the identification of vasa vasorum and intraplaque microvessels. Moreover, plaque neovascularization has been associated with plaque vulnerability and ischemic symptoms lately as well. At the same time, attempts have been made to quantify contrast-enhanced ultrasonography signal using sophisticated software packages and algorithms, and to correlate it with intraplaque microvascular density. The aim of this review was to collect all recent data on the characteristics, performance, and prognostic role of contrast-enhanced ultrasonography regarding carotid stenosis management, and to produce useful conclusions for clinical practice.
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Affiliation(s)
- Konstantinos Filis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Levon Toufektzian
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - George Galyfos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Fragiska Sigala
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Panagiota Kourkoveli
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Manolis Vavuranakis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Dimitrios Vrachatis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - George Zografos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
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Moris D, Karaolanis G, Schizas D, Georgopoulos S. eComment. Mural thrombus in normal appearing aorta: Unfinished saga in uncharted waters. Interact Cardiovasc Thorac Surg 2016; 22:373-4. [PMID: 26874007 DOI: 10.1093/icvts/ivv407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Demetrios Moris
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Athens, Greece
| | - Georgios Karaolanis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Athens, Greece
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Moris D, Georgopoulos S, Felekouras E, Patsouris E, Theocharis S. The effect of endocannabinoid system in ischemia-reperfusion injury: a friend or a foe? Expert Opin Ther Targets 2015; 19:1261-75. [PMID: 25936364 DOI: 10.1517/14728222.2015.1043268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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
INTRODUCTION In recent years, the endocannabinoid system has emerged as a new therapeutic target in variety of disorders associated with inflammation and tissue injury, including those of the neuronal, liver, renal and cardiovascular system. The aim of the present review is to elucidate the effect of endocannabinoid system on ischemia reperfusion injury (IRI) in different organs and systems. AREAS COVERED The MEDLINE/PubMed database was searched for publications with the medical subject heading Cannabinoids* (CBs), CB receptors*, organ*, ischemia/reperfusion injury*, endocannabinoid* and system*. The initial relevant studies retrieved from the literature were 91 from PubMed. This number was initially limited to 35, after excluding the reviews and studies reporting data for receptors other than cannabinoid. EXPERT OPINION CB2 receptors may play an important compensatory role in controlling tissue inflammation and injury in cells of the neuronal, cardiovascular, liver and renal systems, as well as in infiltrating monocytes/macrophages and leukocytes during various pathological conditions of the systems (atherosclerosis, restenosis, stroke, myocardial infarction, heart, liver and renal failure). These receptors limit inflammation and associated tissue injury. On the basis of preclinical results, pharmacological modulation of CB2 receptors may hold a unique therapeutic potential in stroke, myocardial infarction, atherosclerosis, IRI and liver disease.
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Affiliation(s)
- Demetrios Moris
- National and Kapodistrian University of Athens , Anastasiou Gennadiou 56, 11474, Athens , Greece +30 210 6440590 ;
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Bakoyiannis C, Karaolanis G, Moris D, Palla V, Skrapari I, Bastounis E, Georgopoulos S. Homocysteine as a risk factor of restenosis after carotid endarterectomy. INT ANGIOL 2015; 34:166-171. [PMID: 25394952] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Homocysteine (Hcy) has been identified as a potential risk factor for vascular disease. This study investigates the role of serum Hcy as clinical risk factor for restenosis after carotid endarterectomy (CEA). METHODS In a prospective design, we studied patients who underwent carotid endarterectomy with venous patch closure technique with respect to alterations of Hcy levels pre and postoperatively. The patients studied were subjected to reevaluation for possible restenosis at time-points 3, 6, 9, 12, 18 and 24 months postoperatively. RESULTS Fifty-three symptomatic and 37 asymptomatic patients with stenosis of internal carotid artery >70% were studied. Restenosis appeared in 7.25% of the patients within 24 months postoperatively. Hcy was the only parameter that correlated significantly with the presence of restenosis (P=0.010) and the presence of type VI (complicated) atheromatous plaque (P=0.005) within 24 months postoperatively. CONCLUSION Hcy levels were found to be statistically significantly correlated with both the presence of complicated atheromatous plaque and the degree of internal carotid artery restenosis after CEA.
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Affiliation(s)
- C Bakoyiannis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece -
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Bakoyiannis C, Moris D, Georgopoulos S. eComment. Current debates on late conversion after endovascular aneurysm repair: a step-by-step discussion. Interact Cardiovasc Thorac Surg 2014; 19:626. [PMID: 25536675 DOI: 10.1093/icvts/ivu252] [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: 11/14/2022] Open
Affiliation(s)
- Chris Bakoyiannis
- 1st Department of Surgery, "Laikon" General Hospital, Athens, Greece
| | - Demetrios Moris
- 1st Department of Surgery, "Laikon" General Hospital, Athens, Greece
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Moris D, Bakoyiannis C, Georgopoulos S. eComment. Persistent type 2 endoleaks after endovascular aneurysm repair: why and when to intervene? Interact Cardiovasc Thorac Surg 2014; 20:134. [PMID: 25525095 DOI: 10.1093/icvts/ivu372] [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: 11/14/2022] Open
Affiliation(s)
- Demetrios Moris
- Laikon General Hospital, Athens University Medical School, Athens, Greece
| | - Chris Bakoyiannis
- Laikon General Hospital, Athens University Medical School, Athens, Greece
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Antonopoulos CN, Kakisis JD, Giannakopoulos TG, Andrikopoulos V, Antoniadis P, Bessias N, Dervisis K, Georgopoulos S, Giannoukas A, Kaperonis E, Kiskinis D, Klonaris C, Machairas A, Papavassiliou V, Saleptsis V, Saratzis N, Seretis K, Tampakis C, Liapis CD. Rupture After Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2014; 48:476-81. [DOI: 10.1177/1538574414561225] [Citation(s) in RCA: 7] [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: 11/15/2022]
Abstract
A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascular aortic repair (EVAR; rAAAevar) were presented to 7 referral hospitals in Greece, between January 2006 and April 2012. Type Ia endoleak and endograft migration were identified in 72.7% and 50%, respectively. Compliance to follow-up protocol prior to rupture was 31.8%. In-hospital mortality was 36.4% (9.1% for those treated with secondary EVAR and 63.6% for those treated with open surgical repair, P = .02). An increase in the proportion of patients with rAAAevar among the total number of patients with rAAAs from 1.3% in 2007 to 18.2% in 2012 ( P for trend = .04) was recorded, corresponding to an annual increase of 2.8% (b = 2.84, P = .04). Rupture after EVAR seemed to be a clinical entity encountered with increasing frequency over the past years. Type I endoleak and endograft migration were most frequently observed, whereas compliance to follow-up was low.
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Affiliation(s)
| | - John D. Kakisis
- Department of Vascular Surgery, University General Hospital “Attikon”, Athens, Greece
| | | | - Vasilios Andrikopoulos
- Department of Vascular Surgery, General Hospital “Korgialenio—Benakio National Red Cross”, Athens, Greece
| | - Pavlos Antoniadis
- Department of Vascular Surgery, General Hospital “Konstantopoulio—Agia Olga”, Athens, Greece
| | - Nikolaos Bessias
- Department of Vascular Surgery, General Hospital “Korgialenio—Benakio National Red Cross”, Athens, Greece
| | - Konstantinos Dervisis
- Department of Vascular Surgery, General Hospital “Konstantopoulio—Agia Olga”, Athens, Greece
| | | | | | - Elias Kaperonis
- Department of Vascular Surgery, General Hospital “Sismanoglio”, Athens, Greece
| | - Dimitrios Kiskinis
- Department of Vascular Surgery, General Hospital of Thessaloniki “Papageorgiou”, Thessaloniki, Greece
| | - Christos Klonaris
- Department of Vascular Surgery, General Hospital “Laikon”, Athens, Greece
| | | | | | - Vasilios Saleptsis
- Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece
| | - Nikolaos Saratzis
- Department of Vascular Surgery, General Hospital of Thessaloniki “Papageorgiou”, Thessaloniki, Greece
| | | | - Charalambos Tampakis
- Department of Vascular Surgery, General Hospital “Konstantopoulio—Agia Olga”, Athens, Greece
| | - Christos D. Liapis
- Department of Vascular Surgery, University General Hospital “Attikon”, Athens, Greece
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Antonopoulos CN, Kakisis JD, Andrikopoulos V, Dervisis K, Georgopoulos S, Giannoukas A, Kiskinis D, Machairas A, Papavassiliou V, Liapis CD, Antoniadis P, Bessias N, Giannakopoulos TG, Kaperonis E, Klonaris C, Saleptsis V, Saratzis N, Seretis K, Tampakis C. Predictors Affecting In-hospital Mortality of Ruptured Abdominal Aortic Aneurysms: A Greek Multicenter Study. Ann Vasc Surg 2014; 28:1384-90. [DOI: 10.1016/j.avsg.2013.12.028] [Citation(s) in RCA: 9] [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: 08/19/2013] [Revised: 11/20/2013] [Accepted: 12/29/2013] [Indexed: 12/20/2022]
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Papastergiou V, Georgopoulos S, Karatapanis S. Current and Future Insights in H. pylori Eradication Regimens: The Need of Tailoring Therapy. Curr Pharm Des 2014; 20:4521-32. [DOI: 10.2174/13816128113196660726] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/10/2013] [Indexed: 11/22/2022]
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Patelis N, Papoutsis K, Liakopoulos D, Koutsoumpelis A, Bakogiannis C, Georgopoulos S. Postprandial lower limb pain: An unusual presentation of visceral arteries occlusion. Vascular 2014; 23:316-8. [DOI: 10.1177/1708538114545805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case report describes an atypical and unique presentation of mesenteric arteries occlusive disease. The patient presented with typical symptoms of chronic mesenteric ischemia, as well as with an atypical new symptom; postprandial buttock and lower limbs pain. Pain followed the time curve of the postprandial abdominal discomfort, starting 30 min after meals and gradually resolving within 2 h. The patient had been tolerating the signs of chronic mesenteric ischemia quite well by adjusting the quantity of food per meal to relieve symptoms. Angiography showed that the celiac artery, the superior mesenteric artery, and distal aorta were occluded, leaving the inferior mesenteric artery as the only feeding vessel of all abdominal viscera and both the lower limbs. Since an English medical literature search returned only one marginally similar case, we consider this case of iliac arteries’ “steal syndrome” from the inferior mesenteric artery unique.
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Affiliation(s)
- Nikolaos Patelis
- First Department of Surgery, Division of Vascular Surgery, National Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| | - Konstantinos Papoutsis
- First Department of Surgery, Division of Vascular Surgery, National Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| | - Dimitrios Liakopoulos
- First Department of Surgery, Division of Vascular Surgery, National Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| | - Andreas Koutsoumpelis
- First Department of Surgery, Division of Vascular Surgery, National Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| | - Christos Bakogiannis
- First Department of Surgery, Division of Vascular Surgery, National Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Division of Vascular Surgery, National Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
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Athanasiou A, Michalinos A, Alexandrou A, Georgopoulos S, Felekouras E. Inferior mesenteric arteriovenous fistula: Case report and world-literature review. World J Gastroenterol 2014; 20:8298-8303. [PMID: 25009407 PMCID: PMC4081707 DOI: 10.3748/wjg.v20.i25.8298] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/08/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this patient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.
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Georgopoulos S, Kouvelos GN, Koutsoumpelis A, Bakoyiannis C, Lymperi M, Klonaris C, Tsigris C. The effect of revascularization procedures on healing of mixed arterial and venous leg ulcers. INT ANGIOL 2013; 32:368-374. [PMID: 23822939] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The optimal management of venous leg ulcers in patients with concomitant peripheral artery disease (PAD) remains unclear. The aim of the present study was to evaluate the effectiveness of revascularization procedures in healing of the ulcers of mixed etiology. METHODS During a 6-year period a total of 20 patients with evidence of chronic venous insufficiency, impaired arterial perfusion (ABI<0.75) and active leg ulcer were treated. Patients with moderate PAD (0.5<ABI<0.75) were treated conservatively with modified compression and were considered for revascularization if the ulcer did not heal, while those with severe PAD (ABI<0.5) underwent revascularization. RESULTS Eleven out of seventeen (64.7%) limbs with moderate arterial disease showed a significant healing progress after modified compression and healed at an average time of 24.7±3.1 weeks, while the other 6 limbs (35.3%) failed to improve underwent revascularization and healed at an average time of 16±2.6 weeks. Three limbs with severe arterial disease underwent revascularization and healed at an average time of 17.6±2.5 weeks. Overall the nine arterial interventions had a 100% technical success rate, while ABI improved from 0.54±0.07 to 0.94±0.04 after the intervention. The 30-day mortality was null. Healing time in patients treated with revascularization was significantly lower compared to those treated conservatively (16.6±2.6 weeks vs. 24.7±3.2 weeks, P<0.001). During the follow-up period (48.7±14.3 months), there were 9 ulcer recurrences, 6 in the group of conservative treatment and 3 in the group of revascularization. No significant difference in recurrences between the two groups (log rank=0.772, P=0.38) was demonstrated. CONCLUSION A protocol-driven therapeutic strategy that includes a revascularization procedure as a therapeutic option in patients with ulcers of mixed etiology may be beneficial. Based on the current data, it is essential the therapeutic strategy to be individualized by including an overall risk assessment accounting for comorbidities of the patient and the risk of the procedure.
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Affiliation(s)
- S Georgopoulos
- Unit of Vascular Surgery, 1st Department of Surgery, University of Athens, Medical School, Athens, Greece.
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