Stefan Schulte - Academia.edu (original) (raw)

Papers by Stefan Schulte

Research paper thumbnail of Isolated iliac artery aneurysms: Endovascular versus open elective repair

Journal of Vascular Surgery, 2007

Objective: To compare endovascular and open repair of isolated or solitary iliac artery aneurysms... more Objective: To compare endovascular and open repair of isolated or solitary iliac artery aneurysms (SIAAs). Methods: We present the results of 55 patients with 58 SIAAs that were treated between January 1998 and December 2005 in two European university hospitals. In one center, the standard procedure, if not contraindicated, was endovascular repair, and 32 (58.2%) consecutive patients with 33 SIAAs were treated by using only endovascular techniques (endovascular iliac aneurysm repair; EVIAR). In the second center, 23 (41.8%) consecutive patients with 25 SIAAs were treated by conventional surgical techniques because advanced endovascular skills were not available before late 2005. EVIAR included coil embolization of the hypogastric artery in 13 of the 33 cases with aneurysmal involvement of the internal iliac artery. In the "open" group of patients, midline laparotomy and a transperitoneal approach with bifurcated aortoiliac graft replacement was performed in 4 cases, and a lower lateral abdominal incision with a retroperitoneal approach and iliac replacement was performed in 19 cases. Results: The mean follow-up period was similar in both groups (EVIAR, 35.3 ؎ 21.3 months; open, 31.3 ؎ 19.9 months). The two groups of patients had similar demographic and clinical characteristics compared with previous reported series, and data analysis revealed a statistically significant difference between the two groups only in hypertension. The early and mid-term outcomes and especially the 3-year primary patency rates were also similar between the two groups (EVIAR, 97%; open, 100%). In the EVIAR group, there was no evidence of endoleaks, kinking, or graft migration, and 26 aneurysms remained stable, whereas in 7 aneurysms a slight decrease in size (>10% in diameter) was observed. Comparison of operative time, intraoperative blood loss, and postoperative hospital stay revealed significant differences (P < .001) in favor of the endovascular group. Secondary intervention was not necessary in any patient in either group during the entire follow-up period. Conclusions: Elective management with endovascular or open techniques of isolated iliac aneurysms can be accomplished with very low morbidity and mortality rates. Better intraoperative and early postoperative outcomes, as well as the durable mid-term results in our EVIAR-treated patients, indicate that endovascular techniques could be offered as first-line therapy of SIAAs.

Research paper thumbnail of Surgical outcome of degenerative versus postreconstructive extracranial carotid artery aneurysms

Journal of Vascular Surgery, 2009

Objectives: Extracranial carotid artery aneurysms (ECAAs) are rare vascular lesions, and large se... more Objectives: Extracranial carotid artery aneurysms (ECAAs) are rare vascular lesions, and large series with short-term and long-term outcomes are seldom reported. This study compared the clinical presentation and conventional treatment outcomes of different ECAA types according to their etiology. Methods: We retrospectively reviewed the data of 55 consecutive patients (47 men, 8 women) with 61 ECAAs who were treated from January 1986 to December 2007 by conventional surgical techniques. The patients were a mean age of 65 ؎ 11 years (range, 30-92 years). Thirty-two ECAAs (52.5%) occurred postoperatively after previous carotid endarterectomy, of which 26 patients had 29 degenerative aneurysms (47.5%). Clinical presentation included cerebral stroke in three patients (4.9%) and transient ischemic attack in 26 (42.7%). Mean follow-up was 42.7 ؎ 22.0 months. Statistical analysis was performed within and between degenerative and post-reconstructive ECAA subgroups of patients. Results: Open aneurysm resection included 27 extended polytetrafluoroethylene interposition grafts, 12 venous grafts, and 22 closures using synthetic patch. Cumulative 1-year primary patency rates were 86.9% for the degenerative ECAAs and 96% for the postoperative ECAAs, with respective secondary patency rate at 5 years of 80% and 93.3%. The 5-year patency rate was 88.9% for synthetic grafts compared with 66.7% for vein grafts and 86.4% for synthetic patches. These differences were not statistically significant (P > .05). Complications for the degenerative ECAAs included two reconstruction thromboses <30 days, two cerebral strokes, and one myocardial infarction. The patients with postoperative ECAAs experienced one early thrombosis and two strokes postoperatively. Two patients (3.6%) from the degenerative ECAA subgroup died of cardiac decompensation (n ‫؍‬ 1) and cerebral ischemic event (n ‫؍‬ 1). Conclusions: Despite the different trends, no significant differences were found between degenerative ECAA and postoperative ECAA patients in clinical presentation, localization, and surgery outcomes. The good middle-term and long-term patency rates of synthetic graft reconstruction justify its use in the treatment of ECAAs, and it is less time consuming and technically demanding compared with vein interposition graft.

Research paper thumbnail of E-MISAGO – the largest ongoing real life registry of Misago SX nitinol stent in daily use – Clinical Outcome at 1 year

Background: Interim analysis of the first 1000 patients treated with Misago RX nitinol stent in i... more Background: Interim analysis of the first 1000 patients treated with Misago RX nitinol stent in iliac and femoropopliteal arteries at 1 year follow-up. Methods: e-MISAGO enrolled more than 3000 patients treated with the Misago stent in 94 European centers. All clinical data collected through an EDC platform are fully monitored and all reported serious adverse events are independently adjudicated. Primary safety (at 30 days) and efficacy endpoint (at 1 year) match the VIVA criteria. Results: Patients (68% male) were 67±10 years old, 63% were smokers, 36% had diabetes mellitus (36% IDDM), 46% had hypercholesterolemia and 76% arterial hypertension. Patients had history of previous coronary artery disease in 32% of the cases and 14% previous myocardial infarction. Claudication and symptomatic ischemia concerned 99% and 96% of the patient population. Mean lesion length was 64.5±59.0 mm, with reference vessel diameter 6.3± 1.3 mm. Mean lesions' stenosis was 88.6±12.4% and 43.3% of the...

Research paper thumbnail of Endovascular Treatment of Iatrogenic and Traumatic Carotid Artery Dissection

CardioVascular and Interventional Radiology, 2008

This paper reports on the early and midterm results of endovascular treatment of acute carotid ar... more This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable and self-expanding stents were placed using a transfemoral approach. Success in restoring the carotid lumen was achieved in all patients. No procedure-related complications occurred. All patients experienced significant clinical improvement while in the hospital and achieved complete long-term recovery. At follow-up (mean, 22.4 months), good luminal patency of the stented segments was observed. In conclusion, in this small series, primary stent-supported angioplasty seems to be a safe and effective strategy in the treatment of selected patients having acute traumatic extracranial carotid artery dissection, with excellent early and midterm results. Larger series and longer-term follow-up are required before definitive recommendations can be made.

Research paper thumbnail of Two-dimensional versus three-dimensional CT angiography in analysis of anatomical suitability for stentgraft repair of abdominal aortic aneurysms

Acta Radiologica, 2011

Background The morphological analysis prior to endovascular abdominal aneurysm repair (EVAR) play... more Background The morphological analysis prior to endovascular abdominal aneurysm repair (EVAR) plays an important role in long-term outcomes. Post-imaging analysis of computed tomographic angiography (CTA) by three-dimensional reconstruction with central lumen line detection (CLL 3D-CTA) enables measurements to be made in orthogonal slices. This might be more precise than equal post-imaging analysis in axial slices by two-dimensional computed tomographic angiography (2D-CTA). Purpose To evaluate the intra- and interobserver variability of CLL 3D-CTA and 2D-CTA post-imaging analysis methods and the agreement between them in pre-EVAR suitability analysis of patients with abdominal aortic aneurysm (AAA). Material and Methods Anonymized CTA data-sets from 70 patients with AAA were analyzed retrospectively. Length measurements included proximal and distal aortic neck lengths and total distance from the lower renal artery to the higher iliac bifurcation. Width measurements included proximal...

Research paper thumbnail of The role of epidural spinal cord stimulation in the treatment of Buerger’s disease

Journal of Vascular Surgery, 2005

Purpose: This clinical, retrospective study is evaluated the effect of epidural spinal cord stimu... more Purpose: This clinical, retrospective study is evaluated the effect of epidural spinal cord stimulation (SCS) in the treatment of Buerger's disease. Methods: The clinical criteria of Shionoya were used to diagnose 29 patients (22 men, 7 women; mean age 33.7 years) with Buerger's disease. The patients underwent SCS. Complete physical examination and vascular laboratory data were available and recorded for all patients. Questions regarding the improvement of symptoms, in lifestyle, and in physical activities were asked direct interview or by telephone during mean follow-up of 4 years. Results: The regional perfusion index (RPI), the ratio between the foot and chest transcutaneous oxygen pressure at baseline (before SCS treatment) was 0.27 ؎ 0.25. Three months after SCS implantation the RPI increased to 0.41 ؎ 0.22. During the follow-up period, a sustained improvement in microcirculation was recorded: the RPI at 1-year follow-up was 0.49 ؎ 0.34 and at 3-year follow-up was 0.52 ؎ 0.21. The most pronounced improvement in the RPI values was found in the subgroup of 13 patients with trophic lesions. In this group, the RPI increased significantly from 0.17 ؎ 0.21 to 0.4 ؎ 0.18 (P < .023) after a mean follow-up of 5.7 years. Two patients underwent major amputation of the lower target limb. The limb survival rate was 93.1%. During the follow-up period of 4 years, 21 of the 29 patients continued to smoke, and only five patients stopped nicotine exposure. Conclusions: We recorded a significant benefit in the microcirculation, a good limb survival rate, and the absence of new trophic lesions. During the follow-up period, no severe complications related to the implanted devices occurred. Because of the diffuse, distal, segmental nature of the disease, SCS should be considered as an alternative treatment modality in patients with Buerger's disease.

Research paper thumbnail of Isolated iliac artery aneurysms: Endovascular versus open elective repair

Journal of Vascular Surgery, 2007

Objective: To compare endovascular and open repair of isolated or solitary iliac artery aneurysms... more Objective: To compare endovascular and open repair of isolated or solitary iliac artery aneurysms (SIAAs). Methods: We present the results of 55 patients with 58 SIAAs that were treated between January 1998 and December 2005 in two European university hospitals. In one center, the standard procedure, if not contraindicated, was endovascular repair, and 32 (58.2%) consecutive patients with 33 SIAAs were treated by using only endovascular techniques (endovascular iliac aneurysm repair; EVIAR). In the second center, 23 (41.8%) consecutive patients with 25 SIAAs were treated by conventional surgical techniques because advanced endovascular skills were not available before late 2005. EVIAR included coil embolization of the hypogastric artery in 13 of the 33 cases with aneurysmal involvement of the internal iliac artery. In the "open" group of patients, midline laparotomy and a transperitoneal approach with bifurcated aortoiliac graft replacement was performed in 4 cases, and a lower lateral abdominal incision with a retroperitoneal approach and iliac replacement was performed in 19 cases. Results: The mean follow-up period was similar in both groups (EVIAR, 35.3 ؎ 21.3 months; open, 31.3 ؎ 19.9 months). The two groups of patients had similar demographic and clinical characteristics compared with previous reported series, and data analysis revealed a statistically significant difference between the two groups only in hypertension. The early and mid-term outcomes and especially the 3-year primary patency rates were also similar between the two groups (EVIAR, 97%; open, 100%). In the EVIAR group, there was no evidence of endoleaks, kinking, or graft migration, and 26 aneurysms remained stable, whereas in 7 aneurysms a slight decrease in size (>10% in diameter) was observed. Comparison of operative time, intraoperative blood loss, and postoperative hospital stay revealed significant differences (P < .001) in favor of the endovascular group. Secondary intervention was not necessary in any patient in either group during the entire follow-up period. Conclusions: Elective management with endovascular or open techniques of isolated iliac aneurysms can be accomplished with very low morbidity and mortality rates. Better intraoperative and early postoperative outcomes, as well as the durable mid-term results in our EVIAR-treated patients, indicate that endovascular techniques could be offered as first-line therapy of SIAAs.

Research paper thumbnail of Surgical outcome of degenerative versus postreconstructive extracranial carotid artery aneurysms

Journal of Vascular Surgery, 2009

Objectives: Extracranial carotid artery aneurysms (ECAAs) are rare vascular lesions, and large se... more Objectives: Extracranial carotid artery aneurysms (ECAAs) are rare vascular lesions, and large series with short-term and long-term outcomes are seldom reported. This study compared the clinical presentation and conventional treatment outcomes of different ECAA types according to their etiology. Methods: We retrospectively reviewed the data of 55 consecutive patients (47 men, 8 women) with 61 ECAAs who were treated from January 1986 to December 2007 by conventional surgical techniques. The patients were a mean age of 65 ؎ 11 years (range, 30-92 years). Thirty-two ECAAs (52.5%) occurred postoperatively after previous carotid endarterectomy, of which 26 patients had 29 degenerative aneurysms (47.5%). Clinical presentation included cerebral stroke in three patients (4.9%) and transient ischemic attack in 26 (42.7%). Mean follow-up was 42.7 ؎ 22.0 months. Statistical analysis was performed within and between degenerative and post-reconstructive ECAA subgroups of patients. Results: Open aneurysm resection included 27 extended polytetrafluoroethylene interposition grafts, 12 venous grafts, and 22 closures using synthetic patch. Cumulative 1-year primary patency rates were 86.9% for the degenerative ECAAs and 96% for the postoperative ECAAs, with respective secondary patency rate at 5 years of 80% and 93.3%. The 5-year patency rate was 88.9% for synthetic grafts compared with 66.7% for vein grafts and 86.4% for synthetic patches. These differences were not statistically significant (P > .05). Complications for the degenerative ECAAs included two reconstruction thromboses <30 days, two cerebral strokes, and one myocardial infarction. The patients with postoperative ECAAs experienced one early thrombosis and two strokes postoperatively. Two patients (3.6%) from the degenerative ECAA subgroup died of cardiac decompensation (n ‫؍‬ 1) and cerebral ischemic event (n ‫؍‬ 1). Conclusions: Despite the different trends, no significant differences were found between degenerative ECAA and postoperative ECAA patients in clinical presentation, localization, and surgery outcomes. The good middle-term and long-term patency rates of synthetic graft reconstruction justify its use in the treatment of ECAAs, and it is less time consuming and technically demanding compared with vein interposition graft.

Research paper thumbnail of E-MISAGO – the largest ongoing real life registry of Misago SX nitinol stent in daily use – Clinical Outcome at 1 year

Background: Interim analysis of the first 1000 patients treated with Misago RX nitinol stent in i... more Background: Interim analysis of the first 1000 patients treated with Misago RX nitinol stent in iliac and femoropopliteal arteries at 1 year follow-up. Methods: e-MISAGO enrolled more than 3000 patients treated with the Misago stent in 94 European centers. All clinical data collected through an EDC platform are fully monitored and all reported serious adverse events are independently adjudicated. Primary safety (at 30 days) and efficacy endpoint (at 1 year) match the VIVA criteria. Results: Patients (68% male) were 67±10 years old, 63% were smokers, 36% had diabetes mellitus (36% IDDM), 46% had hypercholesterolemia and 76% arterial hypertension. Patients had history of previous coronary artery disease in 32% of the cases and 14% previous myocardial infarction. Claudication and symptomatic ischemia concerned 99% and 96% of the patient population. Mean lesion length was 64.5±59.0 mm, with reference vessel diameter 6.3± 1.3 mm. Mean lesions' stenosis was 88.6±12.4% and 43.3% of the...

Research paper thumbnail of Endovascular Treatment of Iatrogenic and Traumatic Carotid Artery Dissection

CardioVascular and Interventional Radiology, 2008

This paper reports on the early and midterm results of endovascular treatment of acute carotid ar... more This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable and self-expanding stents were placed using a transfemoral approach. Success in restoring the carotid lumen was achieved in all patients. No procedure-related complications occurred. All patients experienced significant clinical improvement while in the hospital and achieved complete long-term recovery. At follow-up (mean, 22.4 months), good luminal patency of the stented segments was observed. In conclusion, in this small series, primary stent-supported angioplasty seems to be a safe and effective strategy in the treatment of selected patients having acute traumatic extracranial carotid artery dissection, with excellent early and midterm results. Larger series and longer-term follow-up are required before definitive recommendations can be made.

Research paper thumbnail of Two-dimensional versus three-dimensional CT angiography in analysis of anatomical suitability for stentgraft repair of abdominal aortic aneurysms

Acta Radiologica, 2011

Background The morphological analysis prior to endovascular abdominal aneurysm repair (EVAR) play... more Background The morphological analysis prior to endovascular abdominal aneurysm repair (EVAR) plays an important role in long-term outcomes. Post-imaging analysis of computed tomographic angiography (CTA) by three-dimensional reconstruction with central lumen line detection (CLL 3D-CTA) enables measurements to be made in orthogonal slices. This might be more precise than equal post-imaging analysis in axial slices by two-dimensional computed tomographic angiography (2D-CTA). Purpose To evaluate the intra- and interobserver variability of CLL 3D-CTA and 2D-CTA post-imaging analysis methods and the agreement between them in pre-EVAR suitability analysis of patients with abdominal aortic aneurysm (AAA). Material and Methods Anonymized CTA data-sets from 70 patients with AAA were analyzed retrospectively. Length measurements included proximal and distal aortic neck lengths and total distance from the lower renal artery to the higher iliac bifurcation. Width measurements included proximal...

Research paper thumbnail of The role of epidural spinal cord stimulation in the treatment of Buerger’s disease

Journal of Vascular Surgery, 2005

Purpose: This clinical, retrospective study is evaluated the effect of epidural spinal cord stimu... more Purpose: This clinical, retrospective study is evaluated the effect of epidural spinal cord stimulation (SCS) in the treatment of Buerger's disease. Methods: The clinical criteria of Shionoya were used to diagnose 29 patients (22 men, 7 women; mean age 33.7 years) with Buerger's disease. The patients underwent SCS. Complete physical examination and vascular laboratory data were available and recorded for all patients. Questions regarding the improvement of symptoms, in lifestyle, and in physical activities were asked direct interview or by telephone during mean follow-up of 4 years. Results: The regional perfusion index (RPI), the ratio between the foot and chest transcutaneous oxygen pressure at baseline (before SCS treatment) was 0.27 ؎ 0.25. Three months after SCS implantation the RPI increased to 0.41 ؎ 0.22. During the follow-up period, a sustained improvement in microcirculation was recorded: the RPI at 1-year follow-up was 0.49 ؎ 0.34 and at 3-year follow-up was 0.52 ؎ 0.21. The most pronounced improvement in the RPI values was found in the subgroup of 13 patients with trophic lesions. In this group, the RPI increased significantly from 0.17 ؎ 0.21 to 0.4 ؎ 0.18 (P < .023) after a mean follow-up of 5.7 years. Two patients underwent major amputation of the lower target limb. The limb survival rate was 93.1%. During the follow-up period of 4 years, 21 of the 29 patients continued to smoke, and only five patients stopped nicotine exposure. Conclusions: We recorded a significant benefit in the microcirculation, a good limb survival rate, and the absence of new trophic lesions. During the follow-up period, no severe complications related to the implanted devices occurred. Because of the diffuse, distal, segmental nature of the disease, SCS should be considered as an alternative treatment modality in patients with Buerger's disease.