1
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Efthymiou FO, Kakkos SK, Metaxas VI, Dimitroukas CP, Moulakakis KG, Papadoulas SI, Kouri NK, Tsimpoukis AL, Nikolakopoulos KM, Papageorgopoulou CP, Panayiotakis GS. FACTORS INFLUENCING FLUOROSCOPY TIME IN ENDOVASCULAR TREATMENT OF ABDOMINAL ANEURYSMS: A RETROSPECTIVE STUDY. Radiat Prot Dosimetry 2023; 199:443-452. [PMID: 36782000 PMCID: PMC10686527 DOI: 10.1093/rpd/ncad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Patients who undergo endovascular aortic aneurysm repair (EVAR) may require prolonged radiation exposure affected by several factors. The objectives of this study were to document fluoroscopy time (FT) during EVAR and identify possible factors that influence it. A retrospective analysis of a 180 patients' database with abdominal infrarenal aortic aneurysms submitted to EVAR during a 7-y period was performed. The FT is evaluated regarding risk factors and comorbidities, graft type and patient-related, clinical and technical parameters. FT's median (interquartile range) was 1011 (698-1500) s. Excluder and C3 Excluder were associated with significantly lower FT values when compared with other grafts. Hypertension, dyslipidemia, age ≥ 70 y, maximum aneurysm diameter ≥ 6 cm and procedure duration ≥2 h resulted in higher FT values. A significantly lower FT was found for the operations performed in the 7th y of the study's period compared with the previous 6 y, mainly because of the use of Excluder or C3 Excluder grafts. However, these grafts did not show any significant difference in FT values during the 7 y. A significant correlation between FT with age and procedure duration was found. Nevertheless, procedure duration is a poor FT predictor in linear and logistic regressions, although is significantly correlated with FT. Dyslipidemia, procedure duration and graft type are independent predictors of FT larger than the median, whereas only the procedure duration is a predictor for FT larger than the 75th percentile value. The identified factors regarding radiation protection issues should be considered when contemplating abdominal aortic aneurysm repair, however, without compromising the procedure's efficacy. Further work is necessary to identify more potential anatomical, clinical and technical factors affecting procedures' complexity and FT and patient radiation dose during EVAR interventions.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Christos P Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
- Department of Medical Physics, University Hospital of Patras, Patras, Greece
| | | | - Spyros I Papadoulas
- Department of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Natasa K Kouri
- Department of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Andreas L Tsimpoukis
- Department of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | | | | | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
- Department of Medical Physics, University Hospital of Patras, Patras, Greece
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2
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Papadoulas SI, Zotou A, Kouri N, Tsimpoukis A, Zampakis P, Koutsogiannis N, Chroni E. Myasthenia gravis and abdominal aortic aneurysm: a rare combination. Aorta (Stamford) 2023. [PMID: 36940930 DOI: 10.1055/a-2051-7678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Abdominal aortic aneurysm in a patient with myasthenia gravis is extremely rare. We present a 64-year-old male with myasthenia gravis and an asymptomatic abdominal aortic aneurysm treated endovascularly. After extubation he suffered a cardiac arrest due to an acute myocardial infarction. Cardiopulmonary resuscitation and a primary coronary angioplasty led to a satisfactory outcome. Special care is needed due to higher rates of postoperative complications in these patients.
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Affiliation(s)
| | - Anastasia Zotou
- DEPARTMENT OF ANESTHESIOLOGY, University General Hospital of Patras: Panepistemiako Geniko Nosokomeio Patron Panagia e Boetheia, PATRAS, GREECE
| | - Natasa Kouri
- DEPARTMENT OF VASCULAR SURGERY, University General Hospital of Patras: Panepistemiako Geniko Nosokomeio Patron Panagia e Boetheia, PATRAS, GREECE
| | - Andreas Tsimpoukis
- DEPARTMENT OF VASCULAR SURGERY, University General Hospital of Patras: Panepistemiako Geniko Nosokomeio Patron Panagia e Boetheia, PATRAS, GREECE
| | - Petros Zampakis
- DEPARTMENT OF RADIOLOGY, University General Hospital of Patras: Panepistemiako Geniko Nosokomeio Patron Panagia e Boetheia, PATRAS, GREECE
| | - Nikolaos Koutsogiannis
- DEPARTMENT OF CARDIOLOGY, University General Hospital of Patras: Panepistemiako Geniko Nosokomeio Patron Panagia e Boetheia, PATRAS, GREECE
| | - Elisabeth Chroni
- DEPARTMENT OF NEUROLOGY, University General Hospital of Patras: Panepistemiako Geniko Nosokomeio Patron Panagia e Boetheia, PATRAS, GREECE
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3
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Efthymiou FO, Tsimpoukis AL, Papatsirou MA, Kouri NK, Papadoulas SI, Nikolakopoulos KM, Kakkos SK. Endovascular Juxtarenal Aortic Aneurysm Repair Using the ALTO Abdominal Stent Graft System: The First Case Series. Vasc Specialist Int 2022; 38:17. [PMID: 35748180 PMCID: PMC9233984 DOI: 10.5758/vsi.220004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
The ALTO abdominal stent graft system (Endologix Inc., Irvine, CA, USA) is a latest-generation polymer-based device used to treat patients with abdominal aortic aneurysms. The present study describes the first case series of patients with abdominal aortic aneurysms, including two patients with juxtarenal aneurysms, treated using the ALTO stent graft system. Six males were treated using the ALTO device at a single public center. All procedures were uneventful, and the dosimetric results recorded in terms of kerma-area product and fluoroscopy time were similar to those reported in previous studies. At the 1-month follow-up, computed tomography angiography showed no evidence of endoleak, device migration, thrombosis, or structural graft failure. This clinical series demonstrates that the use of the ALTO stent graft system is associated with promising patient outcomes. Lifelong postoperative imaging surveillance may highlight possible late failures and suggest potential graft improvements.
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Affiliation(s)
- Fotios O. Efthymiou
- Departments of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Andreas L. Tsimpoukis
- Departments of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Marianna A. Papatsirou
- Departments of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Natasa K. Kouri
- Departments of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Spyros I. Papadoulas
- Departments of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
| | | | - Stavros K. Kakkos
- Departments of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece
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4
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Papadoulas SI, Theodoropoulou T, Kouri N, Tsimpoukis A, Kitrou P, Papachristou E, Moulakakis KG, Kakkos SK. Treatment of Dialysis Access Steal Syndrome with Concomitant Vascular Access Aneurysms. Vasc Specialist Int 2022; 38:11. [PMID: 35383134 PMCID: PMC8984867 DOI: 10.5758/vsi.220006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022] Open
Abstract
Limb ischemia is a known complication of vascular access that may appear early postoperatively or after years. Over the last few decades, various techniques based on different physiological mechanisms have been used for treatment. A standardized treatment does not exist, and must be individualized based on the flow volume, and the type and location of the access. True and false vascular access aneurysms are another common complication of arteriovenous fistulas, which develop because of venous hypertension or repeated needling. Evidence in the literature regarding treatment of patients with steal syndrome and concomitant true arteriovenous aneurysms is scarce. A female with a brachiocephalic fistula complicated by steal syndrome and vascular access aneurysms was treated successfully with tapered graft placement and aneurysm exclusion.
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Seretis C, Tsimpoukis A, Georgiakakis A, Kitrou P, Panteli E, Papadoulas SI. Patient Transfer with Kocher Forceps on the Axillary Artery: A Rare Case of Ongoing Iatrogenic Vascular Injury. Vasc Specialist Int 2022; 38:10. [PMID: 35383133 PMCID: PMC8984864 DOI: 10.5758/vsi.220010] [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: 02/07/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Iatrogenic trauma of the axillary artery by non-vascular surgeons can occur during various general surgical procedures such as resection of soft tissue tumors or axillary lymph node clearance. Prompt recognition, appropriate initial management, and rapid transfer to a tertiary vascular surgery service, if needed, are key steps to ensuring patient safety. Here we present a case of iatrogenic axillary artery injury during the resection of a recurrent soft tissue tumor in a local hospital. The desperate application of a Kocher clamp on the bleeding axillary artery by the operating general surgeons controlled the bleeding but led to further arterial damage. The patient was transferred to our tertiary hospital, where the arterial injury was repaired using a vein interposition graft. Apart from the encountered intraoperative technical challenges, this case highlights the need for broader training of non-vascular specialist surgeons on the core principles of basic vascular surgical techniques and oncovascular surgery.
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Affiliation(s)
- Charalampos Seretis
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - Andreas Tsimpoukis
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | | | - Panagiotis Kitrou
- Department of Interventional Radiology, University Hospital of Patras, Patras, Greece
| | - Eleftheria Panteli
- Department of Anesthesiology, University Hospital of Patras, Patras, Greece
| | - Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
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6
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Seretis C, Papageorgopoulou CP, Nikolakopoulos KM, Tsimpoukis AL, Papadoulas SI. Complete agenesis of the infra-renal aorta. Clin Case Rep 2021; 9:e04988. [PMID: 34963798 PMCID: PMC8710706 DOI: 10.1002/ccr3.4988] [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: 08/07/2021] [Revised: 09/25/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
Complete agenesis of the infra-renal aorta is an extremely rare anatomical variant, and its presence can complicate the accurate interpretation of the aortic sonographic assessment.
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Affiliation(s)
- Charalampos Seretis
- Department of Vascular SurgeryUniversity General Hospital of PatrasPatrasGreece
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7
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Papageorgopoulou CP, Nikolakopoulos KM, Papadoulas SI. The "double carotid artery" sign: A rare case of spontaneous carotid dissection. Clin Case Rep 2021; 9:e05070. [PMID: 34795899 PMCID: PMC8579907 DOI: 10.1002/ccr3.5070] [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: 08/08/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Carotid artery dissection, which accounts for up to 20% of strokes in young patients, usually extends distally and leads to acute stenosis, occlusion and aneurysmal changes with increased risk for thromboembolic events, especially in young people.
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Papadoulas SI, Kakkos SK. A Stent Graft Visualised Through an Infected Haemodialysis Graft Pseudoaneurysm. Eur J Vasc Endovasc Surg 2018; 57:149. [PMID: 30401515 DOI: 10.1016/j.ejvs.2018.10.005] [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] [Received: 08/16/2018] [Accepted: 10/03/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Spyros I Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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9
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Kakkos SK, Lampropoulos GC, Nikolakopoulos KM, Tsolakis IA, Papadoulas SI, Papachristou EC, Goumenos D, Lazarides MK. A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas. Vasc Specialist Int 2018; 34:51-60. [PMID: 30310807 PMCID: PMC6175573 DOI: 10.5758/vsi.2018.34.3.51] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/06/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose There is currently debate if brachio-basilic vein fistula (BBVF) should be performed as a one-stage or two-stage procedure. The aim of the present study was to perform a systematic review and meta-analysis on BBVF staging. Materials and Methods On February 25, 2016, a search for randomized-controlled trials (RCTs) on BBVF procedures was performed in MEDLINE and Scopus databases. Meta-analyses were performed with fixed-effect or random-effects models as appropriate with risk ratios (RRs). The primary efficacy and safety outcome measures were BBVF maturation and development of complications, respectively. Specific types of complications, including loss of functional secondary patency and long-term complications were all secondary outcome measures. Results We identified three RCTs reporting on 126 patients. Maturation failure of two-stage BBVFs (3/47, 6.4%) was less frequent than one-stage BBVFs (16/79, 20.3%; RR, 0.27; P=0.02). Complication rates of two-stage and one-stage BBVFs were similar (RR, 0.80; P=0.54), but on sensitivity analysis these were less likely to occur with two-stage BBVFs (37% vs. 69% for one-stage BBVFs; RR, 0.57; P=0.03). Two-stage BBVFs were less likely to lose their functional secondary patency (21.3% vs. 31.6% for one-stage BBVFs; RR, 0.61; P=0.11). This non-significant trend became significant (RR, 0.36; P=0.02) on sensitivity analysis. There was no difference in specific complication rates of the two study groups. Conclusion Among candidates for BBVF fistula, there is evidence to suggest that two-stage BBVFs achieve higher maturation rates compared to one-stage BBVFs. The evidence for difference in long-term secondary patency is less robust, calling for further research.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | | | | | - Ioannis A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | | | | | - Miltos K Lazarides
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
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10
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Papadoulas SI, Kakkos SK. Fever of Unknown Origin due to a Mycotic Abdominal Aortic Aneurysm First Diagnosed with Bone 99mTc Scintigraphy. Eur J Vasc Endovasc Surg 2018; 56:698. [PMID: 30279059 DOI: 10.1016/j.ejvs.2018.08.045] [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] [Received: 07/28/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Spyros I Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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11
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Kakkos SK, Timpilis M, Patrinos P, Nikolakopoulos KM, Papageorgopoulou CP, Kouri AK, Ntouvas I, Papadoulas SI, Lampropoulos GC, Tsolakis IA. Acute Effects of Graduated Elastic Compression Stockings in Patients with Symptomatic Varicose Veins: A Randomised Double Blind Placebo Controlled Trial. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Kakkos SK, Kaplanis N, Papachristou EC, Papadoulas SI, Lampropoulos GC, Tsolakis IA, Goumenos D. Response to Commentary on "Is There an Accurate Pre-operative Criterion for Dialysis Access Artery or Vein Diameter?". Eur J Vasc Endovasc Surg 2017; 54:266. [PMID: 28587801 DOI: 10.1016/j.ejvs.2017.04.022] [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: 04/24/2017] [Accepted: 04/29/2017] [Indexed: 11/18/2022]
Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece.
| | - N Kaplanis
- Department of Nephrology, University Hospital of Patras, Patras, Greece
| | - E C Papachristou
- Department of Nephrology, University Hospital of Patras, Patras, Greece
| | - S I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - G C Lampropoulos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - I A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - D Goumenos
- Department of Nephrology, University Hospital of Patras, Patras, Greece
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13
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Kakkos SK, Kaplanis N, Papachristou EC, Papadoulas SI, Lampropoulos GC, Tsolakis IA, Goumenos DS. The Significance of Inflow Artery and Tourniquet Derived Cephalic Vein Diameters on Predicting Successful Use and Patency of Arteriovenous Fistulas for Haemodialysis. Eur J Vasc Endovasc Surg 2017; 53:870-878. [PMID: 28318999 DOI: 10.1016/j.ejvs.2017.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/05/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the significance of inflow artery and cephalic vein diameters on predicting patency of radiocephalic and brachiocephalic arteriovenous fistulas (AVFs). DESIGN Single centre study with retrospective analysis of prospectively collected data between November 2010 and July 2015. METHODS A detailed history and physical examination was undertaken, including age, gender, history and duration of haemodialysis, cause of chronic kidney disease, and the presence of comorbidities/risk factors. Pre-operative arterial and venous upper extremity mapping was performed and inner vessel diameter was recorded, using a tourniquet for the veins. Outcome measures included AVF use (functionality), primary, primary assisted, secondary, and functional secondary patency. RESULTS One hundred and thirty five AVFs (57 and 78 radiocephalic and brachiocephalic AVFs, respectively) were constructed and followed up for 5 years. A cephalic vein diameter <4.3 mm (lower three quartiles) was the single independent predictor of inferior secondary and also functional secondary patency of radiocephalic AVFs (p = .02, HR 11.2, 95% CI 1.44-90.9). A brachial artery diameter ≤4.1 mm (lowest quartile) was an independent predictor of AVF functionality (57% vs. 83% for larger arteries, p = .017), and inferior primary, primary assisted, secondary, and functional secondary patency of brachiocephalic AVFs (primary assisted patency 21.9% vs. 55.9% at 3 years, p = .001/log-rank test, HR 3.1, p = .002/Cox regression). The presence of lower extremity PAD or use of dual antithrombotics was also independently associated with an inferior secondary patency. The number of risk factors (brachial artery diameter ≤4.1 mm, PAD, and use of dual antithrombotics) demonstrated risk stratification capabilities for functional secondary patency. CONCLUSIONS Among patients undergoing radiocephalic AVFs, a tourniquet derived cephalic vein diameter <4.3 mm was the single independent predictor of inferior secondary and functional secondary patency. Among patients undergoing brachiocephalic AVFs, all patency rates were inferior in the presence of a brachial artery diameter ≤4.1 mm and secondary patency was inferior in the presence of multiple risk factors.
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Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Greece.
| | - N Kaplanis
- Department of Nephrology, University Hospital of Patras, Greece
| | | | - S I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Greece
| | - G C Lampropoulos
- Department of Vascular Surgery, University Hospital of Patras, Greece
| | - I A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Greece
| | - D S Goumenos
- Department of Nephrology, University Hospital of Patras, Greece
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14
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Kakkos SK, Papadoulas SI, Tsolakis IA. Letter by Kakkos et al Regarding Article, "Periaortitis as a Rare Complication After Endovascular Aneurysm Repair". Circulation 2015; 132:e353. [PMID: 26621656 DOI: 10.1161/circulationaha.115.017218] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Rio, Patras, Greece
| | - Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Rio, Patras, Greece
| | - Ioannis A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Rio, Patras, Greece
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15
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Kakkos SK, Papazoglou KO, Tsolakis IA, Lampropoulos G, Papadoulas SI, Antoniadis PN. Open Versus Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms. Vasc Endovascular Surg 2015; 49:110-8. [DOI: 10.1177/1538574415602780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Open surgical repair (OSR) of inflammatory abdominal aortic aneurysms (IAAAs) can have significant morbidity. The aim of the present investigation was to compare IAAA outcome after OSR and endovascular aneurysm repair (EVAR) and perform a meta-analysis of the literature. Methods: Twenty-seven patients with an intact IAAA operated on during a 21-year period were included. Results: Nine patients were managed with EVAR and 18 with OSR. In the EVAR group, the number of transfused red blood cell units ( P = .001), procedure duration ( P < .001), and postoperative hospitalization ( P = .004) were significantly reduced compared to OSR. A trend for decreased morbidity with EVAR (11% vs 33% for OSR, P = .36) was observed. On literature review and meta-analysis, morbidity after EVAR was 8.3%, significantly lower compared to OSR (27.4%, P = .047). Mortality for nonruptured IAAAs was 0% after EVAR and 3.6% after OSR ( P = 1.00). Conclusions: Endovascular aneurysm repair of IAAAs is associated with decreased procedure duration, transfusion needs, hospitalization, and morbidity compared to OSR.
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Affiliation(s)
- Stavros K. Kakkos
- Department of Vascular Surgery, University of Patras, Athens, Greece
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16
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Kakkos SK, Ellul J, Ntouvas I, Papadoulas SI. Dual antiplatelet therapy for acute minor ischemic stroke or transient ischemic attack. Ann Transl Med 2015; 3:176. [PMID: 26366393 DOI: 10.3978/j.issn.2305-5839.2015.07.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Stavros K Kakkos
- Departments of Vascular Surgery and Neurology, University Hospital of Patras, Patras, Greece
| | - John Ellul
- Departments of Vascular Surgery and Neurology, University Hospital of Patras, Patras, Greece
| | - Ioannis Ntouvas
- Departments of Vascular Surgery and Neurology, University Hospital of Patras, Patras, Greece
| | - Spyros I Papadoulas
- Departments of Vascular Surgery and Neurology, University Hospital of Patras, Patras, Greece
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17
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Kakkos SK, Tsolakis IA, Papadoulas SI, Lampropoulos GC, Papachristou EE, Christeas NC, Goumenos D, Lazarides MK. Randomized controlled trial comparing primary and staged basilic vein transposition. Front Surg 2015; 2:14. [PMID: 25973421 PMCID: PMC4413520 DOI: 10.3389/fsurg.2015.00014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/09/2015] [Indexed: 11/13/2022] Open
Abstract
Objective It is unclear if brachio-basilic vein fistula should be performed as a primary or staged procedure, particularly for smaller basilic veins. Our aim was to report on a randomized controlled trial comparing these two techniques. Methods Sixteen patients with a basilic vein ≥2.5 mm were randomized into primary transposed brachio-basilic vein (TBBV) fistula (n = 9) and staged TBBV fistula (n = 7). Patients with basilic veins enlarged by previous arteriovenous fistulas were excluded. Baseline characteristics of the two study groups, including vein size, were comparable (median basilic vein diameter 3.5 mm, range 2.8–4.1 mm). The staged group had a brachio-basilic vein fistula performed first followed by the transposition procedure performed at least 6 weeks later to allow the basilic vein to enlarge. TBBV fistula maturation at 10 weeks, primary, assisted-primary, and secondary patency were the primary outcome measures. Early failures were included in the calculation of patency rates. Results Transposed brachio-basilic vein fistula maturation rate after primary procedures (3/9, 33%) was lower compared to maturation rate after staged procedures (7/7, 100%, P = 0.011, Fisher’s exact test), which led to premature termination of the trial. Time to hemodialysis [median (interquartile range)] of primary and staged procedures was 54 (51.5–113.5) days and 97 (93–126) days, respectively (P = 0.16). One-year primary and assisted-primary patency rates of primary and staged procedures were equivalent (44 vs 57%, P = 0.76 and 44 vs 71%, P = 0.29, respectively); however, there was a trend toward a better 1-year secondary patency after staged procedures (86 vs 44% for primary procedures, P = 0.09). Conclusions Among candidates for TBBV fistula with a small basilic vein, staged transposition achieves higher maturation rates compared to primary procedures, a difference reflected in long-term secondary patency. Trial registration www.ClinicalTrials.gov, identifier NCT01274117.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | - Ioannis A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | - Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | | | | | - Nikolaos C Christeas
- Department of Interventional Radiology, University Hospital of Patras , Patras , Greece
| | - Dimitrios Goumenos
- Department of Nephrology, University Hospital of Patras , Patras , Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, Democritus University Hospital , Alexandroupolis , Greece
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Papadoulas SI, Kakkos SK, Kraniotis PA, Manousi ME, Marangos MN, Tsolakis IA. Listeriosis infection of an abdominal aortic aneurysm in a diabetic patient. J Glob Infect Dis 2013; 5:31-3. [PMID: 23599616 PMCID: PMC3628232 DOI: 10.4103/0974-777x.107173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A rare case of an abdominal aortic aneurysm (AAA) infected by Listeria monocytogenes in a 72-year-old male diabetic farmer, is reported. Our patient had a history of a recent pneumonia that could have been caused by Listeria too. Aneurysm infection was manifested by fever and abdominal and back pain, which prompted investigation with CT scanning that revealed a 4.9 cm AAA with typical signs of infection. He underwent urgent AAA repair with aortobifemoral bypass grafting and had an uneventful course. Aneurysm content microbiology revealed Listeria monocytogenes and following a 9-week course of antibiotics our patient remains asymptomatic 11 months later.
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Affiliation(s)
- Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
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