BackgroundRecurrent laryngeal nerve identification is the ‘gold standard’ in thyroidectomy, to de... more BackgroundRecurrent laryngeal nerve identification is the ‘gold standard’ in thyroidectomy, to determine nerve function security and prevent severe complications. This study assessed the topographical relationship between the recurrent laryngeal nerve and the inferior thyroid artery in patients undergoing total thyroidectomy, and determined its clinical impact.MethodsA retrospective study was performed of patients undergoing total thyroidectomy in a single tertiary centre over a six-month period.ResultsSixty-four patients were included. Among the 128 recurrent laryngeal nerve dissections, the nerve was identified traversing the inferior thyroid artery anteriorly in 27.3 per cent, with equal distribution between the two sides. No significant sex association was reported. One patient had transient vocal fold palsy, and hypocalcaemia was observed in 21.9 per cent, yet there was no statistical association with the topographical variation of the recurrent laryngeal nerve.ConclusionAlmost...
AIM To compare the perioperative outcome of patients treated with elective or urgent fenestrated ... more AIM To compare the perioperative outcome of patients treated with elective or urgent fenestrated and branched stent grafting (fbEVAR) for pararenal (pAAA) and thoraco-abdominal aortic aneurysm (TAAA) after previous open with previous endovascular abdominal aortic repair. METHODS Single center retrospective analysis of all patients undergoing fbEVAR after previous open (post-open fbEVAR group) or endovascular abdominal aortic repair (post-endo fbEVAR group) between January 2015 and December 2017. Primary outcomes were technical success and in-hospital all-cause mortality. RESULTS We identified 42 patients undergoing fbEVAR after previous open or endovascular abdominal aortic repair during this period. Twenty-one patients (post-open fbEVAR group) had previous open abdominal aortic repair, 13 with a bifurcated and eight with a tube graft. Of these, two patients presented with pAAA and 19 with TAAA. Twenty-one patients (post-endo fbEVAR group) had previous EVAR. Thirteen patients presented with pAAA, three of them with additional type Ia endoleak, two with stent-graft migration and two with previously failed fEVAR. Eight presented with TAAA. Median interval between previous repair and fbEVAR was 84 months (IQR 60-156) for the post-open fbEVAR group and 72 months (IQR 36-96) for the post-endo fbEVAR group (P=0.746). Eighteen patients (86%) had branched stent grafting in the post-open vs. eleven (52%) in the post-endo group (P<0.01). In two patients in the post-open group, three renal arteries were not catheterized due to severe ostial stenosis, resulting in technical success of 91% in the post-open and 100% in the post-endo fbEVAR group. Four patients (19%) in the post-open fbEVAR group died in hospital, two due to cerebral haemorrhage and two due to pneumonia, and none in the post-endo fbEVAR group (P=0.101). There were five non-stent-graft-related re-interventions, two (10%) in the post-open fbEVAR group and three (14%) in the post-endo fbEVAR group (P=0.844). After 12 months there were four events in the post-endo fbEVAR group: one renal artery stent occluded, one renal artery stent required relining because of disconnection and two type II endoleaks were embolized with coils. There were no re-interventions in the post-open fbEVAR group during 12 months. CONCLUSION Fenestrated and branched repair after previous open or endovascular abdominal aortic repair appears safe with high technical success rate. There is no difference in the technical success and in-hospital all-cause mortality rates between fbEVAR after previous open or endovascular abdominal aortic repair.
Die Therapie von Aneurysmen der deszendierenden thorakalen Aorta hat in den vergangenen Jahren er... more Die Therapie von Aneurysmen der deszendierenden thorakalen Aorta hat in den vergangenen Jahren erhebliche Fortschritte gemacht. Die endovaskuläre Therapie (TEVAR) ist heute in diesem Aortenabschnitt als „golden standard“ anzusehen und ermöglicht die Behandlung auch älterer und kränkerer Patientengruppen. International gibt es zurzeit fünf zwischen 2010 und 2020 veröffentlichte Leitlinien zu Aneurysmen der deszendierenden thorakalen Aorta. Der folgende Artikel präsentiert eine Auswahl von 10 zentralen Empfehlungen der aktuellen Leitlinien im Rahmen der „Gemeinsam-Klug-Entscheiden“-Initiative der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) mit der Zielsetzung, Empfehlungen aus Leitlinien und anderen hochwertigen Quellen in die Praxis zu transferieren, die üblichen Versorgungspraktiken in Deutschland zu hinterfragen und eine Über- wie Unterversorgungen zu vermeiden.
European Journal of Vascular and Endovascular Surgery, 2016
Re: 'Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin ... more Re: 'Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin Therapy' The systematic review of Giannopoulos et al. 1 highlights the existence of increased all-cause and cardiac mortality in asymptomatic carotid disease (ACS) patients even though there is a unanimous use of best medical treatment. In the results of current trials on asymptomatic carotid disease (ACD) a particular concern exists in the interpretation of the impact of optimum medical treatment (OMT). For instance, in the ACST-1, successful carotid endarterectomy (CEA) in patients younger than 75 years of age offered significant benefits in 10-year stroke risk reduction even in those patients who were on statin and antihypertensive treatment. 2 However, the latest ACC/AHA guidelines for patients with ACD recommended aggressive treatment in the reduction of serum lipids with statins and regulating the blood pressure with antihypertensive drugs in order to reduce cardiovascular risk. 3 It still remains unclear whether patients being on statins and antihypertensive treatment in ACST-1 and other relevant trials had adhered to any specific targets. This is of paramount importance, not only for stroke risk reduction perspectives but for the global cardiovascular mortality risk reduction as patients with ACD carry a very high risk of cardiac and all-cause mortality. 1 Therefore, it is very important that future trials in ACD incorporate and record as per protocol the achieved serum lipid, the blood pressure targets and the level of adherence of the recruited patients to these targets over the period of the trial, in order to evaluate the effectiveness of OMT compared with carotid interventions which would be based on in its own pragmatic merits and not on assumptions.
Journal of diabetes and its complications, Jan 13, 2015
One of the diagnostic tools of neuropathetic pain (NP) relies on screening questionnaires includi... more One of the diagnostic tools of neuropathetic pain (NP) relies on screening questionnaires including the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire. To apply and validate the LANSS questionnaire in Greek population. To assess any correlation between LANSS score and visual analog pain scales. A prospective instrument validation study of LANSS was conducted in University Hospital of Larissa, on 70 patients (35 NP and 35 nociceptive pain), from April 2015 to June 2015. Visual analog pain scales (VAS-ADL; impact of pain on daily living activities, VAS-INT; pain intensity) were also assessed and correlated with LANSS scale. The mean age of NP and nociceptive pain group was 67.11±10.05 and 39.14±17.07years respectively. The mean LANSS score was 12.84 (±9.27) in initial test, and 12.54 (±9.41) in the retest evaluation. Cronbach's alpha was 0.895 and 0.901 at initial and retest examinations respectively, both values indicating good internal consistency. NP g...
Purpose: Currently there is no robust evidence which type of bridging stent graft provides better... more Purpose: Currently there is no robust evidence which type of bridging stent graft provides better outcomes after branched endovascular aortic repair (BEVAR). Self-expanding (SESG) and balloon-expandable (BESG) stent grafts are both commonly used to connect branches to their respective target vessels (TV). The aim of the current review was to evaluate the impact of the type of bridging stent grafts on TV outcomes during the mid-term follow-up after BEVAR. Materials and Methods: The study protocol was registered to the PROSPERO (CRD42021274766). A search of the English literature was conducted, using PubMed and EMBASE databases via Ovid and Cochrane database via CENTRAL, from inception to June 30, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Only comparative studies on BEVAR reporting TV outcomes related to BESG vs SESG were considered eligible. Individual studies were assessed for risk of bias using the Newcastle Ottawa Scale...
International angiology : a journal of the International Union of Angiology, 2015
AIM Venous training in Europe is lacking a formal curriculum among various specialties related to... more AIM Venous training in Europe is lacking a formal curriculum among various specialties related to management of venous diseases. We conducted a survey in order to have a snapshot on the actual education and training level among physicians practicing currently venous surgery and phlebology in Europe. METHODS From April 7, 2014 to June 11, 2014 a survey was carried out using the Survey Monkey system, including 11 main questions covering all the domains of training and education in venous surgery and phlebology. The questionnaire was sent to all physicians included in the current mailing list of the European Venous Forum (EVF) and the Mediterranean League of Angiology and Vascular Surgery. Two questions were particularly addressed to those physicians who had attended the EVF hands-on workshop (HOW) at least once. RESULTS The response rate was 24% (97/400) and 51.5% of them were practicing in a hospital service. Most responders were vascular surgeons (67.7%), followed by angiologists (1...
Open surgical repair with aorto-bifemoral bypass grafting is considered as the standard of care f... more Open surgical repair with aorto-bifemoral bypass grafting is considered as the standard of care for the aorto-iliac occlusive disease involving the abdominal aorta, at least in fit patients. On the other hand, substantial risk of peri-operative morbidity and mortality may tarnish the good technical outcomes in higher risk patients. The covered endovascular reconstruction of aorto-iliac bifurcation (CERAB) is a novel minimal invasive approach for aorto-iliac occlusive disease treatment, offering good earlyand mid-term outcomes so far. The procedure consists of the implantation of a wide diameter aortic stent graft and the expansion of two iliac covered stents according to the kissing-technique inside the aortic graft. We report an initial case series of 4 patients treated with the CERAB technique for aorto-iliac occlusive disease treatment. 166 Hellenic Journal of Vascular and Endovascular Surgery | Volume 1 Issue 4 2019 Patients Pre-operative anatomic characteristics Access sites St...
The International Diabetes Federation (IDF) reported that the global prevalence of diabetes (DM) ... more The International Diabetes Federation (IDF) reported that the global prevalence of diabetes (DM) in adults was 8.3% in 2013 expecting to rise beyond 592 million by 2035 with a 10.1% global prevalence [1]. Guidelines have been published for the treatment of this major disease and its complications
Introduction: Percutaneous EVAR (p-EVAR) has gained popularity after the introduction of arteriot... more Introduction: Percutaneous EVAR (p-EVAR) has gained popularity after the introduction of arteriotomy closure devices, as it facilitates a totally minimal invasive technique having a lot of advantages. Duplex ultrasonography (DUS) guided arterial puncture could be mandatory in complications’ prevention. The aim of this study was to evaluate the initial experience of p-EVAR in a tertiary vascular center. Methods: A retrospective study (20172019) with prospectively collected data was undertaken, including all consecutive AAA patients treated using completely percutaneous access. Demographics, pre-operative anatomic parameters and postoperative outcomes were collected. All patients underwent DUS preand post-operatively, while the percutaneous femoral access was also achieved under DUS guidance. The femoral artery out-wall diameter, the presence of atherosclerosis and the distance from the skin were recorded. The technical success, use of additional closure devices, volume of blood trans...
BackgroundRecurrent laryngeal nerve identification is the ‘gold standard’ in thyroidectomy, to de... more BackgroundRecurrent laryngeal nerve identification is the ‘gold standard’ in thyroidectomy, to determine nerve function security and prevent severe complications. This study assessed the topographical relationship between the recurrent laryngeal nerve and the inferior thyroid artery in patients undergoing total thyroidectomy, and determined its clinical impact.MethodsA retrospective study was performed of patients undergoing total thyroidectomy in a single tertiary centre over a six-month period.ResultsSixty-four patients were included. Among the 128 recurrent laryngeal nerve dissections, the nerve was identified traversing the inferior thyroid artery anteriorly in 27.3 per cent, with equal distribution between the two sides. No significant sex association was reported. One patient had transient vocal fold palsy, and hypocalcaemia was observed in 21.9 per cent, yet there was no statistical association with the topographical variation of the recurrent laryngeal nerve.ConclusionAlmost...
AIM To compare the perioperative outcome of patients treated with elective or urgent fenestrated ... more AIM To compare the perioperative outcome of patients treated with elective or urgent fenestrated and branched stent grafting (fbEVAR) for pararenal (pAAA) and thoraco-abdominal aortic aneurysm (TAAA) after previous open with previous endovascular abdominal aortic repair. METHODS Single center retrospective analysis of all patients undergoing fbEVAR after previous open (post-open fbEVAR group) or endovascular abdominal aortic repair (post-endo fbEVAR group) between January 2015 and December 2017. Primary outcomes were technical success and in-hospital all-cause mortality. RESULTS We identified 42 patients undergoing fbEVAR after previous open or endovascular abdominal aortic repair during this period. Twenty-one patients (post-open fbEVAR group) had previous open abdominal aortic repair, 13 with a bifurcated and eight with a tube graft. Of these, two patients presented with pAAA and 19 with TAAA. Twenty-one patients (post-endo fbEVAR group) had previous EVAR. Thirteen patients presented with pAAA, three of them with additional type Ia endoleak, two with stent-graft migration and two with previously failed fEVAR. Eight presented with TAAA. Median interval between previous repair and fbEVAR was 84 months (IQR 60-156) for the post-open fbEVAR group and 72 months (IQR 36-96) for the post-endo fbEVAR group (P=0.746). Eighteen patients (86%) had branched stent grafting in the post-open vs. eleven (52%) in the post-endo group (P<0.01). In two patients in the post-open group, three renal arteries were not catheterized due to severe ostial stenosis, resulting in technical success of 91% in the post-open and 100% in the post-endo fbEVAR group. Four patients (19%) in the post-open fbEVAR group died in hospital, two due to cerebral haemorrhage and two due to pneumonia, and none in the post-endo fbEVAR group (P=0.101). There were five non-stent-graft-related re-interventions, two (10%) in the post-open fbEVAR group and three (14%) in the post-endo fbEVAR group (P=0.844). After 12 months there were four events in the post-endo fbEVAR group: one renal artery stent occluded, one renal artery stent required relining because of disconnection and two type II endoleaks were embolized with coils. There were no re-interventions in the post-open fbEVAR group during 12 months. CONCLUSION Fenestrated and branched repair after previous open or endovascular abdominal aortic repair appears safe with high technical success rate. There is no difference in the technical success and in-hospital all-cause mortality rates between fbEVAR after previous open or endovascular abdominal aortic repair.
Die Therapie von Aneurysmen der deszendierenden thorakalen Aorta hat in den vergangenen Jahren er... more Die Therapie von Aneurysmen der deszendierenden thorakalen Aorta hat in den vergangenen Jahren erhebliche Fortschritte gemacht. Die endovaskuläre Therapie (TEVAR) ist heute in diesem Aortenabschnitt als „golden standard“ anzusehen und ermöglicht die Behandlung auch älterer und kränkerer Patientengruppen. International gibt es zurzeit fünf zwischen 2010 und 2020 veröffentlichte Leitlinien zu Aneurysmen der deszendierenden thorakalen Aorta. Der folgende Artikel präsentiert eine Auswahl von 10 zentralen Empfehlungen der aktuellen Leitlinien im Rahmen der „Gemeinsam-Klug-Entscheiden“-Initiative der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) mit der Zielsetzung, Empfehlungen aus Leitlinien und anderen hochwertigen Quellen in die Praxis zu transferieren, die üblichen Versorgungspraktiken in Deutschland zu hinterfragen und eine Über- wie Unterversorgungen zu vermeiden.
European Journal of Vascular and Endovascular Surgery, 2016
Re: 'Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin ... more Re: 'Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin Therapy' The systematic review of Giannopoulos et al. 1 highlights the existence of increased all-cause and cardiac mortality in asymptomatic carotid disease (ACS) patients even though there is a unanimous use of best medical treatment. In the results of current trials on asymptomatic carotid disease (ACD) a particular concern exists in the interpretation of the impact of optimum medical treatment (OMT). For instance, in the ACST-1, successful carotid endarterectomy (CEA) in patients younger than 75 years of age offered significant benefits in 10-year stroke risk reduction even in those patients who were on statin and antihypertensive treatment. 2 However, the latest ACC/AHA guidelines for patients with ACD recommended aggressive treatment in the reduction of serum lipids with statins and regulating the blood pressure with antihypertensive drugs in order to reduce cardiovascular risk. 3 It still remains unclear whether patients being on statins and antihypertensive treatment in ACST-1 and other relevant trials had adhered to any specific targets. This is of paramount importance, not only for stroke risk reduction perspectives but for the global cardiovascular mortality risk reduction as patients with ACD carry a very high risk of cardiac and all-cause mortality. 1 Therefore, it is very important that future trials in ACD incorporate and record as per protocol the achieved serum lipid, the blood pressure targets and the level of adherence of the recruited patients to these targets over the period of the trial, in order to evaluate the effectiveness of OMT compared with carotid interventions which would be based on in its own pragmatic merits and not on assumptions.
Journal of diabetes and its complications, Jan 13, 2015
One of the diagnostic tools of neuropathetic pain (NP) relies on screening questionnaires includi... more One of the diagnostic tools of neuropathetic pain (NP) relies on screening questionnaires including the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire. To apply and validate the LANSS questionnaire in Greek population. To assess any correlation between LANSS score and visual analog pain scales. A prospective instrument validation study of LANSS was conducted in University Hospital of Larissa, on 70 patients (35 NP and 35 nociceptive pain), from April 2015 to June 2015. Visual analog pain scales (VAS-ADL; impact of pain on daily living activities, VAS-INT; pain intensity) were also assessed and correlated with LANSS scale. The mean age of NP and nociceptive pain group was 67.11±10.05 and 39.14±17.07years respectively. The mean LANSS score was 12.84 (±9.27) in initial test, and 12.54 (±9.41) in the retest evaluation. Cronbach's alpha was 0.895 and 0.901 at initial and retest examinations respectively, both values indicating good internal consistency. NP g...
Purpose: Currently there is no robust evidence which type of bridging stent graft provides better... more Purpose: Currently there is no robust evidence which type of bridging stent graft provides better outcomes after branched endovascular aortic repair (BEVAR). Self-expanding (SESG) and balloon-expandable (BESG) stent grafts are both commonly used to connect branches to their respective target vessels (TV). The aim of the current review was to evaluate the impact of the type of bridging stent grafts on TV outcomes during the mid-term follow-up after BEVAR. Materials and Methods: The study protocol was registered to the PROSPERO (CRD42021274766). A search of the English literature was conducted, using PubMed and EMBASE databases via Ovid and Cochrane database via CENTRAL, from inception to June 30, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Only comparative studies on BEVAR reporting TV outcomes related to BESG vs SESG were considered eligible. Individual studies were assessed for risk of bias using the Newcastle Ottawa Scale...
International angiology : a journal of the International Union of Angiology, 2015
AIM Venous training in Europe is lacking a formal curriculum among various specialties related to... more AIM Venous training in Europe is lacking a formal curriculum among various specialties related to management of venous diseases. We conducted a survey in order to have a snapshot on the actual education and training level among physicians practicing currently venous surgery and phlebology in Europe. METHODS From April 7, 2014 to June 11, 2014 a survey was carried out using the Survey Monkey system, including 11 main questions covering all the domains of training and education in venous surgery and phlebology. The questionnaire was sent to all physicians included in the current mailing list of the European Venous Forum (EVF) and the Mediterranean League of Angiology and Vascular Surgery. Two questions were particularly addressed to those physicians who had attended the EVF hands-on workshop (HOW) at least once. RESULTS The response rate was 24% (97/400) and 51.5% of them were practicing in a hospital service. Most responders were vascular surgeons (67.7%), followed by angiologists (1...
Open surgical repair with aorto-bifemoral bypass grafting is considered as the standard of care f... more Open surgical repair with aorto-bifemoral bypass grafting is considered as the standard of care for the aorto-iliac occlusive disease involving the abdominal aorta, at least in fit patients. On the other hand, substantial risk of peri-operative morbidity and mortality may tarnish the good technical outcomes in higher risk patients. The covered endovascular reconstruction of aorto-iliac bifurcation (CERAB) is a novel minimal invasive approach for aorto-iliac occlusive disease treatment, offering good earlyand mid-term outcomes so far. The procedure consists of the implantation of a wide diameter aortic stent graft and the expansion of two iliac covered stents according to the kissing-technique inside the aortic graft. We report an initial case series of 4 patients treated with the CERAB technique for aorto-iliac occlusive disease treatment. 166 Hellenic Journal of Vascular and Endovascular Surgery | Volume 1 Issue 4 2019 Patients Pre-operative anatomic characteristics Access sites St...
The International Diabetes Federation (IDF) reported that the global prevalence of diabetes (DM) ... more The International Diabetes Federation (IDF) reported that the global prevalence of diabetes (DM) in adults was 8.3% in 2013 expecting to rise beyond 592 million by 2035 with a 10.1% global prevalence [1]. Guidelines have been published for the treatment of this major disease and its complications
Introduction: Percutaneous EVAR (p-EVAR) has gained popularity after the introduction of arteriot... more Introduction: Percutaneous EVAR (p-EVAR) has gained popularity after the introduction of arteriotomy closure devices, as it facilitates a totally minimal invasive technique having a lot of advantages. Duplex ultrasonography (DUS) guided arterial puncture could be mandatory in complications’ prevention. The aim of this study was to evaluate the initial experience of p-EVAR in a tertiary vascular center. Methods: A retrospective study (20172019) with prospectively collected data was undertaken, including all consecutive AAA patients treated using completely percutaneous access. Demographics, pre-operative anatomic parameters and postoperative outcomes were collected. All patients underwent DUS preand post-operatively, while the percutaneous femoral access was also achieved under DUS guidance. The femoral artery out-wall diameter, the presence of atherosclerosis and the distance from the skin were recorded. The technical success, use of additional closure devices, volume of blood trans...
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