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Papers by Neophytos Zambas

Annals of Vascular Surgery, 2013

Endovascular treatment of ruptured aortic aneurysms is performed in many centers around the world... more Endovascular treatment of ruptured aortic aneurysms is performed in many centers around the world. New endovascular stent-grafts may prove to improve results. We report our experience with the Endurant device. From June 2010 to November 2010, we treated five male patients (mean age: 75.8 years) suffering from ruptured abdominal aortic aneurysm with the Endurant device. The mean aneurysm diameter was 90.2 mm; the mean neck length was 13 mm; the mean proximal neck diameter was 27 mm; and the mean proximal angulation was 64°. Technical success rate was 100%. In one patient, a proximal leak was diagnosed intraoperatively, and a proximal extension was successfully deployed. No secondary procedures were necessary and no open conversions required during the first admission. One patient required a proximal extension at 3 months for a type I endoleak. The 30-day mortality was 20%, and no further deaths occurred during the follow-up (mean duration: 15 months). New stent-grafts may ameliorate the prognosis of ruptured abdominal aortic aneurysms. Our experience with the Endurant device has shown promising results. To our knowledge, this is the first report of endovascular treatment of ruptured aortic aneurysms with this stent-graft.

Annals of Vascular Surgery, 2010

Iatrogenic pseudoaneurysms after femoral embolectomy are unusual and have been described in the p... more Iatrogenic pseudoaneurysms after femoral embolectomy are unusual and have been described in the peroneal, posterior tibial, and popliteal arteries. We present an unusual case of such a pseudoaneurysm originating from a medial superior genicular collateral vessel that was coming off the proximal popliteal artery at an acute angle. It is likely that the embolectomy catheter had accidentally entered this branch, which ruptured when the balloon was inflated. Transcatheter coil embolization resulted in successful thrombosis of the pseudoaneurysm.

Annales de Chirurgie Vasculaire, 2010

Les faux an evrysmes iatrog enes apr es embolectomie f emorale sont rares et ont et e d ecrits da... more Les faux an evrysmes iatrog enes apr es embolectomie f emorale sont rares et ont et e d ecrits dans les art eres poplit ee, tibiale post erieure, et p eroni ere. Nous pr esentons un cas peu commun d'un tel faux an evrysme provenant d'une collat erale g enicul ee sup erieure m ediale qui naissait de l'art ere poplit ee proximale a angle aigu. Il est probable que le cath eter d'embolectomie ait accidentellement p en etr e dans cette branche, qui s'est rompue quand le ballon a et e gonfl e. L'embolisation transluminale par spires a eu comme cons equence la thrombose r eussie du faux an evrysme.

The American Journal of Emergency Medicine, 2010

Axillary artery transection after recurrent anterior shoulder dislocation is extremely rare. We p... more Axillary artery transection after recurrent anterior shoulder dislocation is extremely rare. We present 2 such patients. The first, a 62-year-old man, presented with acute ischemia and a large hematoma in the axilla and chest wall. The second, a 63-year-old man, had a pseudoaneurysm and palpable peripheral pulses. Both underwent urgent computed tomography, which confirmed the clinical diagnosis, and the patients were taken to the operating room. In the first patient, intraoperative angiogram through both the brachial and the femoral route showed complete disruption of the axillary artery rendering an endovascular approach not possible. Proximal balloon occlusion was then undertaken through the femoral artery, controlling the bleeding and allowing easier dissection of the ruptured segment. Revascularization was performed with an interposition polytetrafluoroethylene (PTFE) bypass restoring normal blood supply to the upper extremity. The second patient had a Viabhan (W.L. Gore, Flagstaff, Ariz) stent-graft implanted through the brachial artery with an excellent clinical and angiographic result. As expected, both patients had significant neurologic morbidity due to associated brachial plexus palsy. Ruptured axillary artery after shoulder dislocation is very uncommon. Endovascular repair and hybrid procedures combining open and endovascular techniques can offer reliable solutions to these challenging problems.

Annals of Vascular Surgery, 2013

Endovascular treatment of ruptured aortic aneurysms is performed in many centers around the world... more Endovascular treatment of ruptured aortic aneurysms is performed in many centers around the world. New endovascular stent-grafts may prove to improve results. We report our experience with the Endurant device. From June 2010 to November 2010, we treated five male patients (mean age: 75.8 years) suffering from ruptured abdominal aortic aneurysm with the Endurant device. The mean aneurysm diameter was 90.2 mm; the mean neck length was 13 mm; the mean proximal neck diameter was 27 mm; and the mean proximal angulation was 64°. Technical success rate was 100%. In one patient, a proximal leak was diagnosed intraoperatively, and a proximal extension was successfully deployed. No secondary procedures were necessary and no open conversions required during the first admission. One patient required a proximal extension at 3 months for a type I endoleak. The 30-day mortality was 20%, and no further deaths occurred during the follow-up (mean duration: 15 months). New stent-grafts may ameliorate the prognosis of ruptured abdominal aortic aneurysms. Our experience with the Endurant device has shown promising results. To our knowledge, this is the first report of endovascular treatment of ruptured aortic aneurysms with this stent-graft.

Annals of Vascular Surgery, 2010

Iatrogenic pseudoaneurysms after femoral embolectomy are unusual and have been described in the p... more Iatrogenic pseudoaneurysms after femoral embolectomy are unusual and have been described in the peroneal, posterior tibial, and popliteal arteries. We present an unusual case of such a pseudoaneurysm originating from a medial superior genicular collateral vessel that was coming off the proximal popliteal artery at an acute angle. It is likely that the embolectomy catheter had accidentally entered this branch, which ruptured when the balloon was inflated. Transcatheter coil embolization resulted in successful thrombosis of the pseudoaneurysm.

Annales de Chirurgie Vasculaire, 2010

Les faux an evrysmes iatrog enes apr es embolectomie f emorale sont rares et ont et e d ecrits da... more Les faux an evrysmes iatrog enes apr es embolectomie f emorale sont rares et ont et e d ecrits dans les art eres poplit ee, tibiale post erieure, et p eroni ere. Nous pr esentons un cas peu commun d'un tel faux an evrysme provenant d'une collat erale g enicul ee sup erieure m ediale qui naissait de l'art ere poplit ee proximale a angle aigu. Il est probable que le cath eter d'embolectomie ait accidentellement p en etr e dans cette branche, qui s'est rompue quand le ballon a et e gonfl e. L'embolisation transluminale par spires a eu comme cons equence la thrombose r eussie du faux an evrysme.

The American Journal of Emergency Medicine, 2010

Axillary artery transection after recurrent anterior shoulder dislocation is extremely rare. We p... more Axillary artery transection after recurrent anterior shoulder dislocation is extremely rare. We present 2 such patients. The first, a 62-year-old man, presented with acute ischemia and a large hematoma in the axilla and chest wall. The second, a 63-year-old man, had a pseudoaneurysm and palpable peripheral pulses. Both underwent urgent computed tomography, which confirmed the clinical diagnosis, and the patients were taken to the operating room. In the first patient, intraoperative angiogram through both the brachial and the femoral route showed complete disruption of the axillary artery rendering an endovascular approach not possible. Proximal balloon occlusion was then undertaken through the femoral artery, controlling the bleeding and allowing easier dissection of the ruptured segment. Revascularization was performed with an interposition polytetrafluoroethylene (PTFE) bypass restoring normal blood supply to the upper extremity. The second patient had a Viabhan (W.L. Gore, Flagstaff, Ariz) stent-graft implanted through the brachial artery with an excellent clinical and angiographic result. As expected, both patients had significant neurologic morbidity due to associated brachial plexus palsy. Ruptured axillary artery after shoulder dislocation is very uncommon. Endovascular repair and hybrid procedures combining open and endovascular techniques can offer reliable solutions to these challenging problems.