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Papers by Hubert Stępak

Journal of clinical medicine, May 18, 2024

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Polski Przegląd Chirurgiczny, Nov 27, 2023

Cardiovascular radiology/Cardiovascular and interventional radiology, Apr 23, 2024

Purpose The purpose of this study was to evaluate the 5-year real-world results of Supera stent i... more Purpose The purpose of this study was to evaluate the 5-year real-world results of Supera stent implantation in below the knee prosthetic bypasses (BKPBs). All the procedures were performed because of a history of recurrent thrombosis of the graft and significant stenotic kinking of the prosthesis during knee flexion. A Supera stent was implanted to prevent the next potential BKPB thrombosis. Materials and Methods Fourteen patients were included in this single-center, retrospective observational cohort study. All patients underwent Supera stent implantation in infrainguinal prosthetic bypass between 2012 and 2017, due to a history of recurrent thrombosis and kinking of the prosthetic bypass. Results Prior to Supera stent implantation procedure, all the patients had more than one episode of acute limb ischemia caused by thrombosis of the BKPB. The median number of BKPB thromboses prior to Supera stent implantation was 3 and ranged from 2 to 6. Technical success was achieved in all cases. Primary patency rates at 12, 24, 36 and 60 months were 71.4%, 57.1%, 57.1% and 14.3%, respectively. Secondary patency rates at 12, 24, 36 and 60 months were 78.6%, 64.3%, 64.3% and 35.7%, respectively. One stent fracture was reported during 60-month follow-up. Major amputation was performed in 6 patients in 5-year follow-up. Conclusion Supera stent in treatment of recurrent thrombosis of BKBP is a safe procedure with acceptable midterm results. However, larger and comparable prospective studies are needed for broader analysis of this procedure.

Current Pharmaceutical Design, Feb 27, 2019

Background The new oral anticoagulants (NOAC), dabigatran and rivaroxaban, have been demonstrated... more Background The new oral anticoagulants (NOAC), dabigatran and rivaroxaban, have been demonstrated to be at least equivalent to warfarin for preventing cardiac thromboembolism (TE) in patients with atrial fibrillation (AF). However, there is limited data regarding use around catheter ablation (CA) procedures. Objective We evaluated the risk of bleeding and TE complications associated with NOAC use during AF ablation. Methods Consecutive patients undergoing AF ablation between January 2011 and 6 September 2013 were grouped based on peri-procedural anticoagulation regimen: (1) uninterrupted warfarin with therapeutic INR (WARF), n=114, (2) dabigatran, n=89, or (3) rivaroxaban, n=98. NOACs were held for 24 h (dabigatran) or 36 h (rivaroxaban) prior to the procedure. Heparin infusion was initiated 6 h post-procedure for the NOAC groups; NOACs were resumed the morning after the procedure. Antral PVI was performed with activated clotting time (ACT) maintained >300 s. TE or bleeding complications during ablation and through 30 days were compared. Results Three hundred and one patients underwent ablation for paroxysmal (71 %) or persistent (29 %) AF. International Normalization Ratio (INR) for the WARF group was 2.0±0.5. Baseline characteristics were similar among the groups. There were two TE events (asymptomatic cerebral emboli and TIA), and there were 17 bleeding events (large hematoma n=4; pericardial effusion n = 6; persistent hematuria n = 1; pseudoaneurism/AV fistula n = 6). Of the six pericardial effusions, three required drainage. There was no significant difference in combined TE/bleeding risk among the groups (WARF vs. dabigatran vs. rivaroxaban; 6.2 % vs. 6.7 % vs. 6.0 %; p=0.82) Conclusions In this group of AF patients undergoing CA, use of peri-procedure dabigatran or rivaroxaban compared to uninterrupted warfarin did not lead to an increase in bleeding or TE complications.

Annals of Vascular Surgery, 2021

Background The COrona Virus Disease (COVID-19) pandemic has radically changed the possibilities f... more 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 inventorise 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 15th to October 15th 2020. Results 856 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.

European Journal of Vascular and Endovascular Surgery, Jun 1, 2016

WHAT THIS PAPER ADDS A considerable number of patients with AAA are ineligible for endovascular t... more WHAT THIS PAPER ADDS A considerable number of patients with AAA are ineligible for endovascular treatment because of anatomical characteristics. Selection bias presents a significant limitation in studies published on this topic, in particular in terms of aorto-iliac anatomy of the non-Caucasian population. This is the first multicentre study aiming to provide data on morphological vascular differences between Asian and Caucasian populations. It is hoped that it will provide useful data for future stent graft design, thereby increasing the number of patients suitable for EVAR as well as improving the outcome of the procedure. Objective: The objective was to quantify aorto-iliac morphology differences between AAA patients of Caucasian and Asian origin. Additionally, the impact of patient demographic characteristics was assessed, which could influence the morphological differences. Methods: This international multicentre study included two tertiary referral institutions from Europe and one from China. CT scans with 3D reconstruction of 296 patients with infrarenal AAA >5 cm were analysed. Eighteen measurements were recorded from each CT scan and compared between Caucasian and Asian patients. Results: Caucasian patients had longer common iliac arteries (right: 65.0 vs. 33.1 mm, p < .001 left: 65.0 vs. 35.2 mm, p < .001), longer aneurysm neck (33.0 vs. 28.4 mm, p < .001), greater aneurysm to aortic axis angle (153.0 vs. 142.2 , p < .001), and longer combined aorto-iliac length (195.7 vs. 189.2 mm, p < .001). However, Asian patients had a longer infrarenal abdominal aorta (152.0 vs. 130.0 mm, p < .001), longer AAA (126.2 vs. 93.0 mm), and greater linear distance from renal artery to aorto-iliac bifurcation (143.6 vs. 116.0 mm, p < .001). Caucasian patients had a larger inner common iliac artery diameter (right: 16.0 vs. 14.9 mm, p < .001, left: 16.0 vs. 15.2 mm, p < .001), larger inner exernal iliac artery diameter (right: 9.0 vs. 7.5 mm, p < .001 left: 9.0 vs. 7.7 mm, p < .001), and larger inner common femoral artery diameter (right: 10.0 vs. 5.9 mm, p < .001 left: 10.0 vs. 6.1 mm, p < .001). No difference was observed in AAA transverse diameter (62.0 vs. 63.1 mm, p ¼ .492). Conclusion: The results showed that aorto-iliac anatomy in Caucasians differs significantly from Asians, particularly in the length of the common iliac arteries and infrarenal abdominal aorta, and in the transverse diameter of the common, external iliac, and common femoral arteries. Therefore, the exact criteria for stent graft design are dependent on the racial origin of the patient.

Journal of Medical Science, Mar 27, 2017

Traditional surgical repair and endovascular repair (EVAR) are the treatment options for abdomina... more Traditional surgical repair and endovascular repair (EVAR) are the treatment options for abdominal aortic aneurysm repair. EVAR as less invasive becomes a signifi cant and widely accepted way of treatment aortic aneurysms with expanding number of procedures. This technique has a lover short-term mortality and a shorter hospital stay but is not free from complications. The most common complication after EVAR are endoleaks. For the fi rst time summarised and assessed in 1997. Although it is often asymptomatic but may cause aneurysm expanding and rupture. Endoleak is defi ned as persistent blood flow into the aneurysm sac. It can be revealed intra-operatively or during the follow up-CT; arteriography, angio-MRI enables endoleak diagnosis. Usage of duplex sonography is questionable. In this mini-review we summarise endolek diagnostic, classifi cation and treatment options.

Dubai medical journal, Mar 8, 2023

Introduction: With the steady rise in interest in e-learning and the sudden boost provoked by the... more Introduction: 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. Methods: An online survey was conducted during the early phase of the COVID-19 pandemic (June 15-October 15, 2020). Re-Nikolaos Patelis equally contributed as the first author.

Journal of Clinical Medicine

Background: Peripheral artery disease (PAD) remains a major issue in modern societies and affects... more Background: Peripheral artery disease (PAD) remains a major issue in modern societies and affects more than 200 million people around the world. Endovascular methods have been evaluated to be safe and effective in limb salvage. The Supera is able to withstand increased compression, biomechanical stress and to have higher radial force. The objective of this study is to evaluate performance, durability and 3-year patency of Supera stent implantation in severe femoropopliteal disease. Methods: A retrospective real-world analysis was performed with consideration of 77 patients that had a Supera stent implanted with femoropopliteal atherosclerotic disease at a single center. Among the 77 individuals, 92 Supera stents were implanted. Analysis of patients’ demographics, lesions characteristics, reintervention rates and patency rates was performed. Results: The median follow-up was 33 months and ranged from 0 to 84 months. Chronic limb-threatening ischemia was observed among 43 patients. Me...

Wstęp: W dotychczasowych analizach wykazano przydatność badań przesiewowych z wykorzystaniem ultr... more Wstęp: W dotychczasowych analizach wykazano przydatność badań przesiewowych z wykorzystaniem ultrasonografii w zmniejszaniu śmiertelności powodowanej przez pęknięcie tętniaków aorty brzusznej (AAA). Celem badania było określenie częstości występowania tętniaków aorty i niedrożności aortalno-biodrowej w populacji mężczyzn w wieku powyżej 50 lat, z czynnikami ryzyka rozwoju powikłań naczyniowych, z wykorzystaniem obrazowania ultrasonograficznego, mieszkających na terenie Wielkopolski. Materiał i metody: Do analizy włączono 313 mężczyzn w wieku 52-89 lat, przebadanych w okresie od marca 2009 do stycznia 2010 roku, w wieku powyżej 65 lat, z co najmniej jednym czynnikiem rozwoju powikłań sercowo-naczyniowych i w wieku powyżej 50 lat z dodatnim wywiadem rodzinnym w kierunku AAA. U każdej osoby zebrano wywiad, przeprowadzono badanie przedmiotowe, oznaczono wskaźnik kostka-ramię, wykonano badanie dupleksowe aorty i tętnic biodrowych oraz oznaczono glikemię i gospodarkę lipidową. Wyniki: U 14 osób (4,5%) wykryto obecność AAA o średnicy 32-93 mm. W 2 przypadkach pacjentów z tętniakami objawowymi zakwalifikowano do leczenia zabiegowego w trybie pilnym. U osób z AAA stwierdzono znamiennie wyższe stężenie glikemii, częstsze aktualne palenie tytoniu, przebyte udary mózgu oraz występowanie przewlekłej obturacyjnej choroby płuc i chorób układowych. U 11 osób (3,5%) wykryto niedrożność aortalno-biodrową, w tym w 2 przypadkach z objawami krytycznego niedokrwienia. Osoby te charakteryzowały się wyższymi stężeniami cholesterolu całkowitego i frakcji LDL, niższym stężeniem HDL oraz częstszym aktywnym paleniem tytoniu i przebytymi udarami mózgu. Czułość badania palpacyjnego w wykrywaniu AAA wyniosła 21%, natomiast specyficzność badania ultrasonograficznego 100%. Ograniczoną wartość diagnostyczną miało 3,8% oznaczeń USG, z tego w 0,9% przypadków badanie było niediagnostyczne i wymagało powtórzenia. Średnica poszerzonych odcinków aorty oceniona w USG i w angio-CT różniła się o 0-2,4 mm (śr. 1,8 ± 0,6 mm). Wnioski: W przeprowadzonym badaniu potwierdzono, że częstość występowania AAA oraz czynniki ryzyka ich rozwoju w populacji mężczyzn w Wielkopolsce są podobne do opisywanych we wcześniejszych pracach. Wykryto 14 przypadków AAA, z tego 2 wymagające zaopatrzenia w trybie pilnym. Potwierdzono przydatność ultrasonografii jamy brzusznej w wykrywaniu AAA oraz konieczność kontynuacji programu przesiewowego w podobnej formule. Słowa kluczowe: tętniak aorty brzusznej, badania przesiewowe, ultrasonografia jamy brzusznej, badanie dupleksowe, czynniki ryzyka 4 Marcin Gabriel et al. Ultrasound screening of aortic aneurysm and aorto-iliac occlusion detection in males living in Wielkopolska province Polish Surgery 2012 14, 1-2 Abdominal aortic aneurysm (AAA) is a chronic disease which in most cases is accompanied by the absence of manifestations, or those which are unusual. It is often an incidental finding discovered during periodic checkups, abdominal ultrasound scans or chest X-rays performed for unrelated reasons, upon rupture or during an autopsy [1-3]. AAAs account for 2.2% of deaths in men over 60 years of age and 1.2% of deaths in women over 65 years of age [4]. It has been estimated that 66% of patients with a ruptured aneurysm die before surgery with a further 41-48% dying during emergency surgery [5, 6]. The necessity to develop methods for early detection of this pathology is clear given the fact that elective surgery for AAA is associated with a risk of dangerous complications in the range of 3-6% [2-4]. One such method is screening, which reduces the incidence of aneurysmal ruptures by 50%, the incidence of emergency procedures by 56-80%, all-cause mortality by 2% and mortality related to the rupture of the AAA by 21-80% [3, 7-9]. No effective markers associated with the predisposition for developing an AAA have so far been identified. Instead, research has mainly focused on the analysis of biomarkers that show a correlation with the advancement of the destructive processes occurring in the wall of the affected segment of the aorta or on the determination of expression of individual genes [10-12]. The usefulness of palpation in the detection of AAA is assessed as uncertain. Fielding estimated the sensitivity of this method at 91% and for this reason he con

Polish Journal of Cardio-Thoracic Surgery, 2019

Direct oral anticoagulants (DOACs) are the drug of choice for the treatment of atrial fibrillatio... more Direct oral anticoagulants (DOACs) are the drug of choice for the treatment of atrial fibrillation-associated systemic embolism and reducing the risk of strokes in chronic kidney disease (CKD) patients. DOACs have fewer drug-to-drug interactions as well as fewer side effects, compared to warfarin. This article compiled up-to-date research on the use of DOACs in CKD patients, taking the AHA 2019 guidelines into consideration. The aim of this article was to compare the efficacy and safety of DOACs with warfarin and to assess whether DOACs are a better alternative to warfarin. Among DOACs, apixaban has been shown to have the best outcome compared to other DOACs. As a result, the AHA 2019 updated guidelines have recommended warfarin and apixaban to be the first line agents for CKD patients. This review concluded that DOACs are better option in patients with mild to moderate CKD and excluding apixaban other DOACs are not indicated in patients with CrCl < 25 ml/min.

Biocybernetics and Biomedical Engineering, 2018

The currently used criterion of maximum transverse diameter for the Abdominal Aortic Aneurysm tre... more The currently used criterion of maximum transverse diameter for the Abdominal Aortic Aneurysm treatment has some limitations. Therefore, studies aiming at creating an individualized, therapeutic strategies are being conducted. Those include biomechanical assessment of rupture risk of an aneurysm based on the Finite Element Analysis of the geometric models of the aneurysm. The usual approach is to use the results of the computed Q2 tomography imaging to build a three-dimensional model of the aneurysm. The FEA is then performed and the resulting stress is analyzed to estimate the risk of rupture. Although such an approach brings significant improvements over the traditional maximum diameter method, it is difficult to ensure the validity of the assumptions (e.g. the material model) made. This paper presents a method to evaluate the correctness of such a modeling approach. The emergence of gated Magnetic Resonance Imaging (MRI) provides an opportunity to register aneurysm in both the systolic and diastolic phase of cardiac cycle. The corresponding geometric models are built and the results of the FEA applied to the diastolic model are compared with the actual deformation of the aneurysm observed in the patient's bodythe systolic model. As a result, it is possible to verify whether the individualized diagnostic approach applied to a specific patient was correct.

American Journal of Roentgenology, 2009

Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • Pic t o r i a l E s s ay WEB This ... more Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • Pic t o r i a l E s s ay WEB This is a Web exclusive article.

International Journal for Numerical Methods in Biomedical Engineering, 2018

Polish Journal of Surgery

Introduction: The anatomical location of the popliteal artery is one of the greatest challenges f... more Introduction: The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical attributes of the vessel lead to higher rates of restenosis, stent fracture, and occlusion. Some surgeons consider the popliteal artery as a “no stenting zone”. Many specialists favor percutaneous transluminal angioplasty to be the first line of endovascular treatment in the popliteal artery with bail-out stent implantation if the results are suboptimal. The Supera peripheral stent system is a novel stent that has been manufactured with a high degree of flexibility and supposedly might be appropriate for implantation in the popliteal artery. Aim: Evaluation of the performance of Supera stent in isolated popliteal artery disease in comparison to other methods of treatment. Methods: As many as 92 articles were found in the databases and after full-text review, 4 studies matched the inclusion criteria and were evaluated. Results: Primary pate...

Polish Journal of Surgery, 2017

Aim: Under the supervision of the Department of General and Vascular Surgery of Poznan University... more Aim: Under the supervision of the Department of General and Vascular Surgery of Poznan University of Medical Sciences, a questionnaire was distributed online or as a paper version to medical students (MSs) in order to better understand the attitudes towards surgery as a specialty and to determine the reasons why students do and do not choose vascular surgery as their career path. Materials and methods: The questionnaire was distributed online or as a paper version to MSs in the 3rd, 5th, and 6th year of the PUMS 6-year M.D. program. It provided the data on the year of study, grade point average (GPA), sex, age, respondent’s specialty choice, 33 questions with responses on a 1-5 Likert scale (1 was the least important reason and 5 was the most important reason), and 2 questions with socres between 0 and 4. A total of 136 Polish MSs of PUMS completed the survey. Results: For MSs who choose vascular surgery as their career path, “endovascular capabilities of vascular surgery” and “high...

Cardiology journal, 2021

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID... more The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) pandemic has presently stunted the growth of the airline industry. Despite the setbacks, pre-COVID passenger numbers are forecasted to return by as early as 2024. As the industry recovers, the number of long-distance flights will surely continue to increase like it did before the pandemic. The incidence of venous thromboembolism (VTE) following air travel is also likely to increase. Although not common, the unique environment of air travel exposes individuals with particular health conditions to an elevated risk of acquiring VTEs. Numerous factors increasing the risk of developing VTE related to air travel have been identified, including inherited and acquired flight-related aspects. Non-pharmacological approaches to reduce air travel-related VTEs involve simple foot movements, compression socks and stockings, intermittent pneumatic compression devices, a novel modified airline sea...

Wstep: W dotychczasowych analizach wykazano przydatnośc badan przesiewowych z wykorzystaniem ultr... more Wstep: W dotychczasowych analizach wykazano przydatnośc badan przesiewowych z wykorzystaniem ultrasonografii w zmniejszaniu śmiertelności powodowanej przez pekniecie tetniakow aorty brzusznej (AAA). Celem badania bylo określenie czestości wystepowania tetniakow aorty i niedrozności aortalno-biodrowej w populacji mezczyzn w wieku powyzej 50 lat, z czynnikami ryzyka rozwoju powiklan naczyniowych, z wykorzystaniem obrazowania ultrasonograficznego, mieszkających na terenie Wielkopolski. Material i metody: Do analizy wlączono 313 mezczyzn w wieku 52–89 lat, przebadanych w okresie od marca 2009 do stycznia 2010 roku, w wieku powyzej 65 lat, z co najmniej jednym czynnikiem rozwoju powiklan sercowo-naczyniowych i w wieku powyzej 50 lat z dodatnim wywiadem rodzinnym w kierunku AAA. U kazdej osoby zebrano wywiad, przeprowadzono badanie przedmiotowe, oznaczono wskaźnik kostka–ramie, wykonano badanie dupleksowe aorty i tetnic biodrowych oraz oznaczono glikemie i gospodarke lipidową. Wyniki: U 1...

Acta Angiologica, Mar 14, 2017

The abdominal aortic aneurysm is tenth most common cause of death in Western countries. Since max... more The abdominal aortic aneurysm is tenth most common cause of death in Western countries. Since maximal transverse diameter as indication for surgical interventions is often criticized, biomechanics of the aneurysm has been studied to develop new criteria for a treatment. The Finite Element Method is being utilized to predict vessel stability. Computer simulations are proven to have high accuracy of rupture risk assessment, although the impact of all incorporated factors is still not fully known. The objective of this paper is to review the most commonly used biomechanical components of computer analysis, including geometry of the vessel, mechanical properties of the wall, thrombus and calcification, their impact on rupture risk, and methods of modelling blood pressure. Comprehension and precise assessment of biomechanics of aneurysm in terms of Finite Element Analysis have high potential in clinical management of abdominal aortic aneurysm.