John Kakisis - Academia.edu (original) (raw)
Papers by John Kakisis
International Journal of Angiology, 2015
Annals of vascular surgery, Jan 10, 2015
The decision for revascularization in patients with near total ICA occlusion still remains contro... more The decision for revascularization in patients with near total ICA occlusion still remains controversial. We undertook an extensive review of the literature and conducted a meta-analysis aiming to investigate the appropriate therapeutic approach for patients with near total ICA occlusion. A multiple electronic health database search was performed on all articles published up to December of 2014. All available data were analyzed giving emphasis on the applied therapeutic approach (best medical therapy; BMT, carotid endarterectomy; CEA, carotid artery stenting; CAS) whereas the main endpoints of the meta-analysis were TIA, stroke, stroke-related death, MI, MAE, overall mortality and restenosis. Five articles on BMT and CEA, 8 articles on CEA and 11 articles on CAS were deemed eligible. A statistically significant difference was recorded in pooled stroke incidence rates (IRs) per 100 p-ys of BMT (IR=6.19) compared to CEA (IR=2.24; p=0.002) and CAS (IR=1.64; p<0.001) studies. No stat...
Stroke, 2001
Background and Purpose-The ability to predict future strokes in asymptomatic patients with caroti... more Background and Purpose-The ability to predict future strokes in asymptomatic patients with carotid stenosis is currently limited. The management of symptomatic patients with Ͻ50% stenosis is also debatable. In this context, we performed the following open prospective study to identify factors affecting symptomatology in patients with carotid stenosis. Methods- During 1988During -1997 arteries with various degrees of stenosis were followed with the use of color Duplex ultrasonography every 6 months. The main outcome measures were development of symptoms related to the carotid territory and progression in the degree of stenosis. Results of follow-up were analyzed in relation to the traditional risk factors for atherosclerosis as well as the ultrasonographic characteristics of the plaques. Statistical analysis was performed by multiple linear and Cox regression analysis. Results-Mean duration of follow-up was 44 months (range, 12 to 120 months). Significant progression of stenosis occurred in 18.5% of the cases and was more frequent in younger patients (Pϭ0.09), in patients with coronary artery disease (Pϭ0.02), and in patients with echolucent plaques (Pϭ0.02). In regard to clinical presentation, men (Pϭ0.07), hypertensives (Pϭ0.07), and patients with echolucent plaques (Pϭ0.09) showed a trend toward higher frequency of stroke in their history. During the follow-up period, neurological events developed in 12.4% of the cases and were associated with the severity of carotid disease (PϽ0.001), history of neurological events (Pϭ0.02), progression of stenosis (Pϭ0.002), echolucent plaques (Pϭ0.01), and hypertension (Pϭ0.02). Conclusions-Factors other than degree of stenosis and history of neurological events are also important in determining high-risk carotid plaque. In our study hypertension, echolucent plaques, and progressive lesions were associated with an increased risk of neurological events. These factors should be taken into consideration in determining treatment strategies for carotid stenosis. (Stroke. 2001;32:2782-2786.)
World Journal of Surgery, 2000
The purpose of this retrospective study is to present our approach to the management of patients ... more The purpose of this retrospective study is to present our approach to the management of patients with carotid body tumors (CBTs), emphasizing the role of malignancy and preoperative embolization. Between 1975 and 1998 a series of 18 patients with CBTs were treated, and 16 of them underwent successful excision of the tumor. According to the Shamblin classification, six of the tumors were type I, six type II, and six type III. In three of these patients (two with type II tumors and one with type III) in whom preoperative embolization had been performed, mean intraoperative blood loss was 400 ml, whereas in the remaining 13 cases this loss was 700 ml. Two patients with intracranial tumor spread underwent only radiotherapy. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in four cases (25%). Local lymph node invasion was found in two patients, establishing the diagnosis of malignancy. One of these patients developed distal metastases 3 years after the operation and was treated with radiotherapy and octreotide. Follow-up ranging from 30 months to 23 years (mean 5 years) revealed no local recurrence except for the two patients who were treated with radiotherapy only. In conclusion, surgical excision remains the treatment of choice for CBTs and can be performed without major risks and with low morbidity and mortality. Preoperative embolization is helpful by diminishing intraoperative bleeding, and malignancy, though rare justifies early management.
Endothelium-journal of Endothelial Cell Research, 2004
Hemodynamic forces, including shear stress and cyclic strain, have been recognized as important m... more Hemodynamic forces, including shear stress and cyclic strain, have been recognized as important modulators of vascular cell morphology and function. The mechanism by which vascular cells sense and transduce the extracellular mechanical signals into the cell nucleus has only recently begun to come to light. Integrins, ion channels, platelet-derived growth factor receptors, and G proteins have been recognized as mechanosensors, converting the mechanical stimuli into chemical signals. Activation of second messengers, including mitogen-activated protein kinases, protein kinase C, and Akt, follows, leading to an increase in the activity of transcription factors such as activator protein (AP)-1, AP-2, cAMP-responsive element (CRE), early growth response (Egr)-1, and nuclear factor (NF)-kappa B. Binding of these factors to the DNA leads to activation of numerous genes that regulate cell proliferation, apoptosis, differentiation, morphology, migration, and secretory function. Understanding of these responses has provided new insights in the pathogenesis and treatment of vascular diseases, such as atherosclerosis and intimal hyperplasia.
Annals of cardiothoracic surgery, 2014
The management of acute type B dissection represents a clinical challenge. We undertook a systema... more The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and endovascular treatments of acute type B aortic dissection and combined the eligible studies into a meta-analysis. An extensive electronic health database search was performed on all articles published from January 2006 up to November 2013 describing the management of acute type B aortic dissection. Studies including less than 15 patients were excluded. ACUTE COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia (SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total of 1,276 patients underwent open surgical repair and the pooled rate for 30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular eve...
Journal of the mechanical behavior of biomedical materials, 2015
Mechanical testing and in-depth characterization of the abdominal aortic aneurysm wall from fifte... more Mechanical testing and in-depth characterization of the abdominal aortic aneurysm wall from fifteen patients undergoing open surgery was performed to establish the layer-dependent tissue properties that are non-available in the literature. Quantitative microscopic evaluation was performed to identify the spatial organization of collagen-fiber network. Among a number of candidate models, the four-fiber family (microstructure-motivated) model, especially that including dispersions of fiber angles about the main directions, was superior to the Fung- and Gasser-type models in the fitting quality allowed, though it presented a practical difficulty in parameter estimation, so that an analysis was conducted aiding the identification of a more specific diagonal- and circumferential-fiber family model for all three layers. The adventitia was stiffer and stronger than the other layers, owing to its increased collagen content, and its contribution to the response of the intact wall was augment...
Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2015
To evaluate inflammatory response and renal function after thoracic endovascular aortic repair (T... more To evaluate inflammatory response and renal function after thoracic endovascular aortic repair (TEVAR) of lesions in the descending thoracic aorta. Thirty-two consecutive patients treated with TEVAR from January 2010 to August 2013 were enrolled in this prospective study. Two were excluded owing to dissecting thoracic aortic aneurysm (TAA) extending into the renal arteries with renal failure in one and a saccular TAA in which a multilayer flow-modulating stent was implanted in the other. This left 30 patients (28 men; mean age 68.8±5.9 years) with 28 TAAs, an aortic dissection, and an aortic ulcer for the analysis. Temperature and serum levels of white blood cells (WBCs), C-reactive protein (CRP), interleukin-10 (IL-10), IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), creatinine, urea, and cystatin C were measured preoperatively and at 24 and 48 hours postoperatively. Statistically significant increases in temperature and serum levels of WBCs, CRP, IL-10, and IL-6 were observed 24 ...
The International journal of angiology : official publication of the International College of Angiology, Inc, 2015
Secondary aortoenteric fistula (SAEF) is a rare, life-threatening complication of aortic reconstr... more Secondary aortoenteric fistula (SAEF) is a rare, life-threatening complication of aortic reconstructive surgery. Graft excision associated with gut repair and extra-anatomic bypass or in situ aortic reconstruction is the best option. However, it is associated with high mortality rates, especially when undertaken in unstable patients with severe comorbidities. We present a case of SAEF successfully treated by endovascular repair and gut restoration. After laparotomy, a dense inflammatory "frozen" mass was found around the involved part of the duodenum and the aortic sac. Because of his comorbidities, the difficulty in dissection of the aortic sac and the risk of damage in adjacent organs, the initial plan for aortic reconstruction was abandoned. A surgical isolation of the third portion of the duodenum and a duodenum-jejunal anastomosis were performed. An Endurant endograft 32-16-16 mm (Medtronic, Inc., Minneapolis, MN) was implanted to achieve aortic continuity. Twenty mon...
Vascular and endovascular surgery
A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascul... more 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.
Vascular, Jan 17, 2014
Extrahepatic portal vein aneurysm is a relatively uncommon entity. We reported the case of a 51-y... more Extrahepatic portal vein aneurysm is a relatively uncommon entity. We reported the case of a 51-year-old man, who was incidentally diagnosed with an asymptomatic 52 × 65 mm portal vein aneurysm, which was located at the main trunk of the portal vein, just before its bifurcation. The patient was treated with partial clamping of the portal vein aneurysm and aneurysmorrhaphy. Postoperative course was uneventful. Surgical intervention should be considered for patients with large, symptomatic or expanding portal vein aneurysms.
Annals of cardiothoracic surgery, 2013
Evolution in the endovascular era has influenced the management of aortic arch pathologies. Sever... more Evolution in the endovascular era has influenced the management of aortic arch pathologies. Several studies have described the use of a combined endovascular and open surgical approach to the treatment of arch diseases. Hybrid repair of arch pathologies has been considered as a less invasive method, and is therefore an appealing option for high-risk patients who are unsuitable for open repairs. The aim of the present meta-analysis was to assess the efficacy of hybrid techniques in patients with aortic arch pathologies. Extensive electronic literature search was undertaken to identify all articles published up to December 2012 that described hybrid aortic arch repair with intrathoracic supra-aortic branch revascularisation and subsequent stent graft deployment. Eligible studies were divided into two groups: group I included studies on the aortic arch debranching procedure and group II included studies that reported an elephant trunk technique (either "frozen" or stented). S...
Annals of cardiothoracic surgery, 2013
Evolution in the endovascular era has influenced the management of aortic arch pathologies. "... more Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aorti...
Urologia internationalis, 2007
De novo carcinoma of the renal transplant is a rare but disastrous clinical entity. We report suc... more De novo carcinoma of the renal transplant is a rare but disastrous clinical entity. We report such a tumor developing 13 years after transplantation and describe its clinical presentation, diagnostic approach and therapy. The importance of a surveillance program allowing early detection of tumor developing in the renal transplant is emphasized.
Journal of vascular surgery, 2005
Artificial blood vessels composed of viable tissue represent the ideal vascular graft. Compliance... more Artificial blood vessels composed of viable tissue represent the ideal vascular graft. Compliance, lack of thrombogenicity, and resistance to infections as well as the ability to heal, remodel, contract, and secrete normal blood vessel products are theoretical advantages of such grafts. Three basic elements are generally required for the construction of an artificial vessel: a structural scaffold, made either of collagen or a biodegradable polymer; vascular cells, and a nurturing environment. Mechanical properties of the artificial vessels are enhanced by bioreactors that mimic the in vivo environment of the vascular cells by producing pulsatile flow. Alternative approaches include the production of fibrocollagenous tubes within the recipient's own body (subcutaneous tissue or peritoneal cavity) and the construction of an artificial vessel from acellular native tissues, such as decellularized small intestine submucosa, ureter, and allogeneic or xenogeneic arteries. This review d...
Journal of Endovascular Therapy, 2014
Annals of Vascular Surgery, 2009
Cement embolism of the pulmonary arteries is a well-known complication of percutaneous vertebropl... more Cement embolism of the pulmonary arteries is a well-known complication of percutaneous vertebroplasty as well as orthopedic procedures involving instrumentation of the medullary canal. A few cases of paradoxical cement embolism have also been described. Herein, we report a case of cortical bone void filler embolism to the infragenicular arteries during revision spine surgery. The cement had entered the aorta via the left L3 lumbar artery. To the best of our knowledge, this is the first report of embolism due to direct arterial migration of cement during an orthopedic procedure.
Annales de Chirurgie Vasculaire, 2009
Ath enes, Gr ece L'embolie pulmonaire de ciment est une complication connue de la vert ebroplasti... more Ath enes, Gr ece L'embolie pulmonaire de ciment est une complication connue de la vert ebroplastie percutan ee et des interventions orthop ediques sur le canal m edullaire. Quelques cas d'embolie paradoxale de ciment ont egalement et e rapport es. Ici, nous rapportons un cas d'embolie de produit de comblement d'os cortical au niveau des art eres jambi eres durant une chirurgie rachidienne it erative. Le ciment a gagn e l'aorte via la troisi eme art ere lombaire gauche. A notre connaissance, il s'agit du premier cas d'embolie due a la migration intra art erielle directe de ciment durant une intervention orthop edique.
Anales de Cirugía Vascular, 2009
La insuficiencia de la vena safena interna est a presente en hasta un 20% de los pacientes con ve... more La insuficiencia de la vena safena interna est a presente en hasta un 20% de los pacientes con venas varicosas. Los estudios que examinan las tasas de eficacia y complicaciones asociadas a la ablaci on endovenosa con l aser de la vena safena interna s olo incluyen un reducido n umero de pacientes. Los autores describen el caso de una mujer de 50 añ os de edad que present o edema doloroso de la pierna derecha. Ten ıa antecedentes de ablaci on endovenosa previa con l aser de ambas venas safenas externas y de la vena safena interna de la pierna derecha. Se efectu o examen con eco-Doppler que demostr o una f ıstula arteriovenosa entre ramas de la arteria y la vena popl ıtea. Se efectu o la ligadura quir urgica de la f ıstula. A los 8 meses de seguimiento, la paciente permanece asintom atica.
International Journal of Angiology, 2015
Annals of vascular surgery, Jan 10, 2015
The decision for revascularization in patients with near total ICA occlusion still remains contro... more The decision for revascularization in patients with near total ICA occlusion still remains controversial. We undertook an extensive review of the literature and conducted a meta-analysis aiming to investigate the appropriate therapeutic approach for patients with near total ICA occlusion. A multiple electronic health database search was performed on all articles published up to December of 2014. All available data were analyzed giving emphasis on the applied therapeutic approach (best medical therapy; BMT, carotid endarterectomy; CEA, carotid artery stenting; CAS) whereas the main endpoints of the meta-analysis were TIA, stroke, stroke-related death, MI, MAE, overall mortality and restenosis. Five articles on BMT and CEA, 8 articles on CEA and 11 articles on CAS were deemed eligible. A statistically significant difference was recorded in pooled stroke incidence rates (IRs) per 100 p-ys of BMT (IR=6.19) compared to CEA (IR=2.24; p=0.002) and CAS (IR=1.64; p<0.001) studies. No stat...
Stroke, 2001
Background and Purpose-The ability to predict future strokes in asymptomatic patients with caroti... more Background and Purpose-The ability to predict future strokes in asymptomatic patients with carotid stenosis is currently limited. The management of symptomatic patients with Ͻ50% stenosis is also debatable. In this context, we performed the following open prospective study to identify factors affecting symptomatology in patients with carotid stenosis. Methods- During 1988During -1997 arteries with various degrees of stenosis were followed with the use of color Duplex ultrasonography every 6 months. The main outcome measures were development of symptoms related to the carotid territory and progression in the degree of stenosis. Results of follow-up were analyzed in relation to the traditional risk factors for atherosclerosis as well as the ultrasonographic characteristics of the plaques. Statistical analysis was performed by multiple linear and Cox regression analysis. Results-Mean duration of follow-up was 44 months (range, 12 to 120 months). Significant progression of stenosis occurred in 18.5% of the cases and was more frequent in younger patients (Pϭ0.09), in patients with coronary artery disease (Pϭ0.02), and in patients with echolucent plaques (Pϭ0.02). In regard to clinical presentation, men (Pϭ0.07), hypertensives (Pϭ0.07), and patients with echolucent plaques (Pϭ0.09) showed a trend toward higher frequency of stroke in their history. During the follow-up period, neurological events developed in 12.4% of the cases and were associated with the severity of carotid disease (PϽ0.001), history of neurological events (Pϭ0.02), progression of stenosis (Pϭ0.002), echolucent plaques (Pϭ0.01), and hypertension (Pϭ0.02). Conclusions-Factors other than degree of stenosis and history of neurological events are also important in determining high-risk carotid plaque. In our study hypertension, echolucent plaques, and progressive lesions were associated with an increased risk of neurological events. These factors should be taken into consideration in determining treatment strategies for carotid stenosis. (Stroke. 2001;32:2782-2786.)
World Journal of Surgery, 2000
The purpose of this retrospective study is to present our approach to the management of patients ... more The purpose of this retrospective study is to present our approach to the management of patients with carotid body tumors (CBTs), emphasizing the role of malignancy and preoperative embolization. Between 1975 and 1998 a series of 18 patients with CBTs were treated, and 16 of them underwent successful excision of the tumor. According to the Shamblin classification, six of the tumors were type I, six type II, and six type III. In three of these patients (two with type II tumors and one with type III) in whom preoperative embolization had been performed, mean intraoperative blood loss was 400 ml, whereas in the remaining 13 cases this loss was 700 ml. Two patients with intracranial tumor spread underwent only radiotherapy. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in four cases (25%). Local lymph node invasion was found in two patients, establishing the diagnosis of malignancy. One of these patients developed distal metastases 3 years after the operation and was treated with radiotherapy and octreotide. Follow-up ranging from 30 months to 23 years (mean 5 years) revealed no local recurrence except for the two patients who were treated with radiotherapy only. In conclusion, surgical excision remains the treatment of choice for CBTs and can be performed without major risks and with low morbidity and mortality. Preoperative embolization is helpful by diminishing intraoperative bleeding, and malignancy, though rare justifies early management.
Endothelium-journal of Endothelial Cell Research, 2004
Hemodynamic forces, including shear stress and cyclic strain, have been recognized as important m... more Hemodynamic forces, including shear stress and cyclic strain, have been recognized as important modulators of vascular cell morphology and function. The mechanism by which vascular cells sense and transduce the extracellular mechanical signals into the cell nucleus has only recently begun to come to light. Integrins, ion channels, platelet-derived growth factor receptors, and G proteins have been recognized as mechanosensors, converting the mechanical stimuli into chemical signals. Activation of second messengers, including mitogen-activated protein kinases, protein kinase C, and Akt, follows, leading to an increase in the activity of transcription factors such as activator protein (AP)-1, AP-2, cAMP-responsive element (CRE), early growth response (Egr)-1, and nuclear factor (NF)-kappa B. Binding of these factors to the DNA leads to activation of numerous genes that regulate cell proliferation, apoptosis, differentiation, morphology, migration, and secretory function. Understanding of these responses has provided new insights in the pathogenesis and treatment of vascular diseases, such as atherosclerosis and intimal hyperplasia.
Annals of cardiothoracic surgery, 2014
The management of acute type B dissection represents a clinical challenge. We undertook a systema... more The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and endovascular treatments of acute type B aortic dissection and combined the eligible studies into a meta-analysis. An extensive electronic health database search was performed on all articles published from January 2006 up to November 2013 describing the management of acute type B aortic dissection. Studies including less than 15 patients were excluded. ACUTE COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia (SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total of 1,276 patients underwent open surgical repair and the pooled rate for 30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular eve...
Journal of the mechanical behavior of biomedical materials, 2015
Mechanical testing and in-depth characterization of the abdominal aortic aneurysm wall from fifte... more Mechanical testing and in-depth characterization of the abdominal aortic aneurysm wall from fifteen patients undergoing open surgery was performed to establish the layer-dependent tissue properties that are non-available in the literature. Quantitative microscopic evaluation was performed to identify the spatial organization of collagen-fiber network. Among a number of candidate models, the four-fiber family (microstructure-motivated) model, especially that including dispersions of fiber angles about the main directions, was superior to the Fung- and Gasser-type models in the fitting quality allowed, though it presented a practical difficulty in parameter estimation, so that an analysis was conducted aiding the identification of a more specific diagonal- and circumferential-fiber family model for all three layers. The adventitia was stiffer and stronger than the other layers, owing to its increased collagen content, and its contribution to the response of the intact wall was augment...
Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2015
To evaluate inflammatory response and renal function after thoracic endovascular aortic repair (T... more To evaluate inflammatory response and renal function after thoracic endovascular aortic repair (TEVAR) of lesions in the descending thoracic aorta. Thirty-two consecutive patients treated with TEVAR from January 2010 to August 2013 were enrolled in this prospective study. Two were excluded owing to dissecting thoracic aortic aneurysm (TAA) extending into the renal arteries with renal failure in one and a saccular TAA in which a multilayer flow-modulating stent was implanted in the other. This left 30 patients (28 men; mean age 68.8±5.9 years) with 28 TAAs, an aortic dissection, and an aortic ulcer for the analysis. Temperature and serum levels of white blood cells (WBCs), C-reactive protein (CRP), interleukin-10 (IL-10), IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), creatinine, urea, and cystatin C were measured preoperatively and at 24 and 48 hours postoperatively. Statistically significant increases in temperature and serum levels of WBCs, CRP, IL-10, and IL-6 were observed 24 ...
The International journal of angiology : official publication of the International College of Angiology, Inc, 2015
Secondary aortoenteric fistula (SAEF) is a rare, life-threatening complication of aortic reconstr... more Secondary aortoenteric fistula (SAEF) is a rare, life-threatening complication of aortic reconstructive surgery. Graft excision associated with gut repair and extra-anatomic bypass or in situ aortic reconstruction is the best option. However, it is associated with high mortality rates, especially when undertaken in unstable patients with severe comorbidities. We present a case of SAEF successfully treated by endovascular repair and gut restoration. After laparotomy, a dense inflammatory "frozen" mass was found around the involved part of the duodenum and the aortic sac. Because of his comorbidities, the difficulty in dissection of the aortic sac and the risk of damage in adjacent organs, the initial plan for aortic reconstruction was abandoned. A surgical isolation of the third portion of the duodenum and a duodenum-jejunal anastomosis were performed. An Endurant endograft 32-16-16 mm (Medtronic, Inc., Minneapolis, MN) was implanted to achieve aortic continuity. Twenty mon...
Vascular and endovascular surgery
A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascul... more 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.
Vascular, Jan 17, 2014
Extrahepatic portal vein aneurysm is a relatively uncommon entity. We reported the case of a 51-y... more Extrahepatic portal vein aneurysm is a relatively uncommon entity. We reported the case of a 51-year-old man, who was incidentally diagnosed with an asymptomatic 52 × 65 mm portal vein aneurysm, which was located at the main trunk of the portal vein, just before its bifurcation. The patient was treated with partial clamping of the portal vein aneurysm and aneurysmorrhaphy. Postoperative course was uneventful. Surgical intervention should be considered for patients with large, symptomatic or expanding portal vein aneurysms.
Annals of cardiothoracic surgery, 2013
Evolution in the endovascular era has influenced the management of aortic arch pathologies. Sever... more Evolution in the endovascular era has influenced the management of aortic arch pathologies. Several studies have described the use of a combined endovascular and open surgical approach to the treatment of arch diseases. Hybrid repair of arch pathologies has been considered as a less invasive method, and is therefore an appealing option for high-risk patients who are unsuitable for open repairs. The aim of the present meta-analysis was to assess the efficacy of hybrid techniques in patients with aortic arch pathologies. Extensive electronic literature search was undertaken to identify all articles published up to December 2012 that described hybrid aortic arch repair with intrathoracic supra-aortic branch revascularisation and subsequent stent graft deployment. Eligible studies were divided into two groups: group I included studies on the aortic arch debranching procedure and group II included studies that reported an elephant trunk technique (either "frozen" or stented). S...
Annals of cardiothoracic surgery, 2013
Evolution in the endovascular era has influenced the management of aortic arch pathologies. "... more Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aorti...
Urologia internationalis, 2007
De novo carcinoma of the renal transplant is a rare but disastrous clinical entity. We report suc... more De novo carcinoma of the renal transplant is a rare but disastrous clinical entity. We report such a tumor developing 13 years after transplantation and describe its clinical presentation, diagnostic approach and therapy. The importance of a surveillance program allowing early detection of tumor developing in the renal transplant is emphasized.
Journal of vascular surgery, 2005
Artificial blood vessels composed of viable tissue represent the ideal vascular graft. Compliance... more Artificial blood vessels composed of viable tissue represent the ideal vascular graft. Compliance, lack of thrombogenicity, and resistance to infections as well as the ability to heal, remodel, contract, and secrete normal blood vessel products are theoretical advantages of such grafts. Three basic elements are generally required for the construction of an artificial vessel: a structural scaffold, made either of collagen or a biodegradable polymer; vascular cells, and a nurturing environment. Mechanical properties of the artificial vessels are enhanced by bioreactors that mimic the in vivo environment of the vascular cells by producing pulsatile flow. Alternative approaches include the production of fibrocollagenous tubes within the recipient's own body (subcutaneous tissue or peritoneal cavity) and the construction of an artificial vessel from acellular native tissues, such as decellularized small intestine submucosa, ureter, and allogeneic or xenogeneic arteries. This review d...
Journal of Endovascular Therapy, 2014
Annals of Vascular Surgery, 2009
Cement embolism of the pulmonary arteries is a well-known complication of percutaneous vertebropl... more Cement embolism of the pulmonary arteries is a well-known complication of percutaneous vertebroplasty as well as orthopedic procedures involving instrumentation of the medullary canal. A few cases of paradoxical cement embolism have also been described. Herein, we report a case of cortical bone void filler embolism to the infragenicular arteries during revision spine surgery. The cement had entered the aorta via the left L3 lumbar artery. To the best of our knowledge, this is the first report of embolism due to direct arterial migration of cement during an orthopedic procedure.
Annales de Chirurgie Vasculaire, 2009
Ath enes, Gr ece L'embolie pulmonaire de ciment est une complication connue de la vert ebroplasti... more Ath enes, Gr ece L'embolie pulmonaire de ciment est une complication connue de la vert ebroplastie percutan ee et des interventions orthop ediques sur le canal m edullaire. Quelques cas d'embolie paradoxale de ciment ont egalement et e rapport es. Ici, nous rapportons un cas d'embolie de produit de comblement d'os cortical au niveau des art eres jambi eres durant une chirurgie rachidienne it erative. Le ciment a gagn e l'aorte via la troisi eme art ere lombaire gauche. A notre connaissance, il s'agit du premier cas d'embolie due a la migration intra art erielle directe de ciment durant une intervention orthop edique.
Anales de Cirugía Vascular, 2009
La insuficiencia de la vena safena interna est a presente en hasta un 20% de los pacientes con ve... more La insuficiencia de la vena safena interna est a presente en hasta un 20% de los pacientes con venas varicosas. Los estudios que examinan las tasas de eficacia y complicaciones asociadas a la ablaci on endovenosa con l aser de la vena safena interna s olo incluyen un reducido n umero de pacientes. Los autores describen el caso de una mujer de 50 añ os de edad que present o edema doloroso de la pierna derecha. Ten ıa antecedentes de ablaci on endovenosa previa con l aser de ambas venas safenas externas y de la vena safena interna de la pierna derecha. Se efectu o examen con eco-Doppler que demostr o una f ıstula arteriovenosa entre ramas de la arteria y la vena popl ıtea. Se efectu o la ligadura quir urgica de la f ıstula. A los 8 meses de seguimiento, la paciente permanece asintom atica.