Papers by Konstantinos Spanos
Journal of Clinical Medicine
Background: Most data in carotid stenosis treatment arise from randomized control trials (RCTs) a... more Background: Most data in carotid stenosis treatment arise from randomized control trials (RCTs) and cohort studies. The aim of this meta-analysis was to compare 30-day outcomes in real-world practice from centers providing both modalities. Methods: A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. Only studies reporting on 30-day outcomes from centers, where both techniques were performed, were eligible for this analysis. Results: In total, 15 articles were included (16,043 patients). Of the patients, 68.1% were asymptomatic. Carotid artery stenting (CAS) did not differ from carotid endarterectomy (CEA) in terms of stroke (odds ratio (OR) 0.98; 0.77–1.25; I2 = 0%), myocardial ischemic events (OR 1.03; 0.72–1.48; I2 = 0%) and all events (OR 1.0; 0.82–1.21; I2 = 0%). Pooled stroke incidence in asymptomatic pat...
European Journal of Vascular and Endovascular Surgery
Journal of Endovascular Therapy
Objectives The aim of this study is to report the safety and effectiveness of thoracic endovascul... more Objectives The aim of this study is to report the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in a native proximal landing zone (PLZ) 2 for chronic type B aortic dissection (TBAD) patients with genetic aortic syndrome (GAS). Methods A retrospective review of a single center database to identify patients with GAS treated with TEVAR in native PLZ 2 for chronic TBAD and thoracic false lumen aneurysm between February 2012 and February 2018 was undertaken. Results In total, 31 patients with GAS (24 Marfan syndrome [MFS], 5 Loeys-Dietz syndrome [LDS], and 2 vascular Ehlers-Danlos syndrome [vEDS]) were treated by endovascular repair. Nineteen patients were treated by TEVAR as index procedures with 8 patients (5 females, mean age = 55, range = 36–79 years old) receiving TEVAR in native PLZ 2. Left subclavian artery (LSA) perfusion was preserved in all 8 patients: by left common carotid artery-LSA bypass in 6 patients, chimney stenting of the LSA in 1 patient, and...
Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2022
Angiology, 2017
We thank Biteker et al for the opportunity to clarify some issues regarding our observational stu... more We thank Biteker et al for the opportunity to clarify some issues regarding our observational study. The International Working Group on the Diabetic Foot guidance has recommended that diabetic foot infection (DFI) must be diagnosed clinically, based on the presence of local or systemic signs or symptoms of inflammation (strong recommendation; low level of evidence) and to assess the severity of any DFI using classification scheme (strong recommendation; moderate level of evidence). Within this context, we focused mainly in adhering to those recommendations in our observational study; thus, all patients underwent clinical evaluation for the presence of infection and were assessed according to 3 classification systems—the University of Texas wound classification, the DFI wound score based on Study of Infections in Diabetic feet comparing Efficacy, Safety and Tolerability of Ertapenem versus Piperacillin/Tazobactam trial, and wound, ischemia, and foot infection classification system of...
The Journal of cardiovascular surgery, 2020
INTRODUCTION The widespread use of endovascular repair in thoracic aorta (TEVAR) pathologies has ... more INTRODUCTION The widespread use of endovascular repair in thoracic aorta (TEVAR) pathologies has ameliorated post-operative outcomes. This meta-analysis was designed to investigate the intra-operative use of transesophageal echocardiography (TEE) compared to angiography in patients undergoing TEVAR. EVIDENCE ACQUISITION The meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until November 30, 2019. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence and the summary of findings for each of the included outcomes. EVIDENCE SYNTHESIS The final analysis included 7 articles (183 patients). All patients underwent TEVAR using intra-operative TEE and angiography. The sensitivity and specificity rates of entry points were 0.624 (95%...
Journal of Endovascular Therapy, 2021
Purpose: The purpose of this study was to evaluate early and mid-term results of non-standard man... more Purpose: The purpose of this study was to evaluate early and mid-term results of non-standard management of the supraaortic target vessels with the use of the inner branch arch endograft in a single high-volume center. Material and methods: A single-center retrospective study including all patients undergoing implantation of an inner branch arch endograft from December 2012 to March 2021, who presented a non-standard management of the supraaortic target vessels (any bypass other than a left carotid-subclavian or landing in a dissected target vessel). Technical success, mortality, reinterventions, endoleak (EL), and aortic remodeling at follow-up were analyzed. Results: Twenty-four patients were included. In 17 (71%) cases, the non-standard management was related to innominate artery (IA) compromise (12 with IA dissection, 2 with short IA, 2 with short proximal aortic landing zone that required occlusion of IA, 1 with occluded IA after open arch repair). Two (8%) cases were related t...
Annals of Vascular Surgery, 2021
PURPOSE The administration of unfractionated heparin (UFH) during endovascular repair of blunt tr... more PURPOSE The administration of unfractionated heparin (UFH) during endovascular repair of blunt traumatic aortic injury (BTAI) is controversial. The aim of the study is to report the early outcomes of patients undergoing thoracic endovascular repair (TEVAR) for BTAI, and to assess the individualized intra-operative use and dose of UFH. METHODS This is a retrospective analysis including consecutive patients treated with TEVAR for BTAI of the descending aorta between 1st of January 2005 and 31st of December 2018. Intra-operative use and doses of UFH were analysed. Primary outcome included a re-intervention because of new onset bleeding and/or thromboembolic complication and 30-day mortality. Technical success, Injury severity score (ISS), timing of treatment and neurologic deterioration were secondary outcome. RESULTS Thirty-six patients with a mean age of 47 ± 18 years, 30 males (83%), were included. Intra-operative administration of UFH was recorded in 30/36 patients (83%) with a mean dose of 4750 ± 2180 IU. Two patients had no UFH because of extensive intracranial hemorrhage or suspected relevant liver laceration, respectively; one died in theatre; one was already anticoagulated having a mechanical aortic valve and in two no information about heparin use was found. During 30-days of follow up, three patients died (8%; 3/36): one patient with completely transected aorta died on-table and two on the 5th postoperative day, one from trauma associated brain injury and one with multi organ failure. No bleeding or thromboembolic complication requiring re-intervention occurred in any patient during 30 days follow-up. In three patients partial unintentional coverage of the LCCA occurred, resulting in technical success of 89% (32/36). Mean ISS was 43 ± 15. Thirty-five patients (97%) were severely injured having an ISS ≥ 25. Twenty-nine patients (81%) were treated within 24 hours and six patients (17%) within one week. No stroke or spinal cord ischemia was observed. CONCLUSIONS Systemic heparinization in different doses during TEVAR for BTAI can be safe with no intra-operative bleeding or thromboembolic complications in early postoperative period.
International Angiology, 2021
INTRODUCTION Endovascular aneurysm repair (EVAR) has become the treatment of choice for abdominal... more INTRODUCTION Endovascular aneurysm repair (EVAR) has become the treatment of choice for abdominal aortic aneurysm (AAA), demonstrating excellent early outcomes. However, EVAR durability has been questioned in the long-term period. The aim of this study was to assess EVAR outcomes in terms of survival and freedom from re-intervention during a long-term period. METHODS All consecutive patients being treated, with elective standard EVAR, in a single tertiary center, were included between 2008 and 2018. Outcomes were defined as survival and freedom from re-intervention and were reported using Kaplan-Meyer lifetables. In subgroup analyses, sex, age (threshold at 65 and 80 years), neck diameter>28mm and type of fixation were also analyzed. Type of re-intervention and endoleak type I (ETIa) were also reported. RESULTS 508 patients (94% males, mean age 72±7.3, mean AAA diameter 59±9mm) were included. The median follow-up was 3 years (range 0-10 years). The survival rate was 92.8% (SE 1.5%), 76.5% (SE 3.1%) and 41.6% (SE 6%), at 2, 5 and 10 years of follow-up, respectively. In total, 78 patients died; 8 deaths (8/75, 10%) were aneurysm related. In multivariate regression analysis, age (CI. 1.02-1.14; p=0.006) and ever tobacco use (CI. 1.02-6.12, P=0.045) were associated with the long-term mortality. Freedom from re-intervention was 96% (SE 1.1%), 93% (SE 1.8%), 85.5% (SE 5%) at 2, 5 and 9 years of follow-up. Limb occlusion was a common complication (n/n; 30% of re-intervention), particularly within the first 2 post-operative years. Six patients presented with rupture and were treated with open conversion. EVAR cases with supra-renal fixation graft presented lower rates of ETIa (CI. 76-87.27, P<0.001). CONCLUSIONS Elective standard EVAR is associated with good long-term survival showing low aneurysm-related mortality. Common risk factors such as advanced age and smoking are associated to higher mortality. The procedure presents low reintervention rates, while limb occlusion is a complication presented within the first 2 post-operative years.
Journal of Endovascular Therapy, 2020
The development of endovascular techniques has improved abdominal aortic aneurysm (AAA) managemen... more The development of endovascular techniques has improved abdominal aortic aneurysm (AAA) management over the past 2 decades. Different cardiovascular societies worldwide have recommended the endovascular approach as the standard of care in their currently available guidelines. While endovascular treatment has established its role in daily clinical practice, a new debate has arisen regarding the indications, appropriateness, limitations, and role of open surgery. To inform this debate, the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched from 2010 to May 2020; the systematic search identified 5 articles published between 2011 and 2020 by 4 cardiovascular societies and the National Institute of Health and Care Excellence (NICE). Four debatable domains were assessed and analyzed: diagnostic methods and screening, preoperative management, indications and treatment modalities, and postoperative follow-up and endoleak management. The review addres...
CardioVascular and Interventional Radiology, 2021
The article “Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection... more The article “Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection”, written by Konstantinos Spanos and Tilo Kölbel, was originally published Online First without Open Access.
Journal of Endovascular Therapy, 2021
Cardiovascular societies have developed recommendations regarding the management of thoracic aort... more Cardiovascular societies have developed recommendations regarding the management of thoracic aortic diseases. While improvements in treatment have been observed during the past decade in regard to patient selection, thoracic endovascular aortic repair (TEVAR) and associated techniques, and high-volume centralization, the broad expansion of TEVAR has raised considerations about its indications, appropriateness, limitations, and application. The aim of this systematic review was to assess the similarities and differences among current cardiovascular societies’ guidelines for the management of thoracic aortic diseases. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from January 2009 to May 2020. The initial search identified 990 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from cardiovascular societies published between 2010 and 2020. Selected controversial topics were analyzed, including...
International Angiology, 2021
INTRODUCTION High-grade internal carotid stenosis results in impaired flow dynamics in the ocular... more INTRODUCTION High-grade internal carotid stenosis results in impaired flow dynamics in the ocular circulation that may lead to a rare clinical entity; ophthalmic ischemic syndrome (OIS). The aim of this study was to investigate hemodynamic changes in the ophthalmic circulation after carotid revascularization, assessed with duplex ultrasonography (DUS), and their potential impact on ocular function in patients suffering from OIS. EVIDENCE ACQUISITION A systematic review of the literature was performed according to the PRISMA guidelines. MEDLINE, EMBASE and CENTRAL databases were searched. EVIDENCE SYNTHESIS The analysis included fourteen cohort studies (589 patients) reporting on the hemodynamic effect of carotid revascularization on the ophthalmic circulation using DUS. Eighty-five per cent of patients were treated for symptomatic carotid stenosis. The pre- and post-operative ophthalmological evaluation was recorded in four studies (227 out of 358 patients (63%) diagnosed with OIS). Reversed ophthalmic artery (OA) flow prior to carotid revascularization was present in 86 cases (24%). Following carotid revascularization, a significant increase in peak systolic velocity (PSV) (mean difference (MD) 14.712 cm/s, 95% confidence interval (CI) 10.566-18.858; p<0.001, I2=96%) and a significant anterograde restoration of flow in the OA (OR 2.047, 95% CI 1.72-2.42, p<0.001, Ι2=0%) were recorded. Carotid revascularization resulted in regression of ischemic symptoms in 93.1% of patients (95% CI 56.4%-99.3%), P=0.001, I2=82%). CONCLUSIONS Carotid revascularization may be associated with a significant flow restoration and PSV increase in the OA; as well as clinical improvement in ischemic ophthalmic symptoms in patients with OIS.
Journal of Endovascular Therapy, 2020
Purpose: To compare the outcomes of iliac branch devices (IBD) used in combination with standard ... more Purpose: To compare the outcomes of iliac branch devices (IBD) used in combination with standard endovascular aneurysm repair (EVAR) vs with fenestrated/branched EVAR (f/bEVAR) to treat complex aortoiliac aneurysms. Materials and Methods: The pELVIS Registry database containing the outcomes of IBD use at 8 European centers was interrogated to identify all IBD procedures that were combined with either standard EVAR or f/bEVAR. Among 669 patients extracted from the database, 629 (mean age 72.1±8.8 years; 597 men) had received an IBD combined with standard EVAR vs 40 (mean age 71.1±8.0 years; 40 men) who underwent f/bEVAR with an IBD. The mean aortic aneurysm diameters were 46.4±13.3 mm in the f/bEVAR patients vs 45.0±15.5 mm in the standard EVAR cases. The groups were similar in terms of baseline clinical characteristics and aneurysm morphology. The Kaplan-Meier method was used to compare patient survival, IBD occlusion, type III endoleak, and aneurysm-related reinterventions in follo...
Journal of the Mechanical Behavior of Biomedical Materials, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
CardioVascular and Interventional Radiology, 2020
In recent guidelines of international societies, the most frequent indication for treatment after... more In recent guidelines of international societies, the most frequent indication for treatment after chronic type B aortic dissection (cTBAD) is aneurysmal dilatation. Endovascular repair is recommended in patients with moderate to high surgical risk or with contraindications to open repair. During the last decade, many advances have been made in the field of endovascular techniques and devices. The aim of this article is to address the current status of endoluminal techniques for the management of cTBAD including standard thoracic endovascular repair, new devices, fenestrated and branched abdominal aortic devices and false lumen occlusion techniques.
International Angiology, 2020
BACKGROUND Screening program in lower extremity atherosclerotic disease (LEAD) has not been widel... more BACKGROUND Screening program in lower extremity atherosclerotic disease (LEAD) has not been widely implemented from health systems. The aim of this study was to assess the incidence of LEAD in Greece though a pilot LEAD screening program. METHODS Males > 60 years old without known diagnosis of LEAD or chronic renal disease were invited through public primary health care institutions to participate in a pilot screening program in Central Greece. Demographics, atherosclerotic risk factors and other co-morbidities were recorded. LEAD was defined as ankle-brachial pressure index (ABPI) of <0.9 or >1.4. RESULTS Among a total of 1152 individuals (invitation acceptance 70%; 1152/1638) LEAD was detected in 13% (148); including 7% with ABPI<0.9 and 6% with ABPI>1.4. Comparing the groups with ABPI<0.9 vs normal ABPI, abnormal ABPI was associated with older age (p=0.001), hypertension (HT) (p=0.037), smoking (p=0.002), duration of smoking (p=0.01), packs/year (p=0.002), coronary artery disease (p=0.02), chronic obstructive pulmonary disease (p=0.028) and cerebrovascular disease (p=0.001). After multivariate analysis, increased age (0.94, CI. 0.026-5.2; p=0.022), history of HT (2.4, CI. 0.44- 3.7; p=0.05) and longer duration of smoking (0.9, CI. 0.01-6.1; 0.013) were associated with ABPI <0.9. Abnormally higher ABPI (>1.4) was not associated with any factor. Among those without known CAD or CVD (96/148), 37.5% (36/96) were on statins and 21% (20/96) on antiplatelets. CONCLUSIONS Incidence of LEAD was 13% in a male >60 years-old population of central Greece; these individuals maybe undertreated. ABPI<0.9 was diagnosed in 7% and was associated with older age, HT and duration of smoking.
Journal of Endovascular Therapy, 2020
Purpose: To describe the implantation steps and tips and tricks for the Inner Branch Arch Endogra... more Purpose: To describe the implantation steps and tips and tricks for the Inner Branch Arch Endograft designed to treat aortic arch aneurysm and chronic type A aortic dissection. Technique: Anatomical suitability criteria should be met in order to use this device. The proximal segment of the graft lands in the ascending aorta distally to the sinotubular junction and the distal segment lands in the descending aorta. The device includes 2 inner branches; the proximal branch is used for a connection to the innominate artery (positioned slightly posterior at 12:30 o’clock), while the second branch is positioned slightly anterior at 11:30 o’clock and is used as a connection to the left common carotid artery. Access, implantation technique, deployment of the device, and catheterization of the branches are described thoroughly. Conclusion: This Inner Branch Arch Endograft is an appealing alternative to treat aortic arch pathology, especially in patients unsuitable for open repair. Neverthele...
Materials Science and Engineering: C, 2018
Carotid endarterectomy (CEA) is one of the approaches available for the treatment of carotid arte... more Carotid endarterectomy (CEA) is one of the approaches available for the treatment of carotid artery disease, with carotid patch angioplasty the pertinent technique mostly preferred by vascular surgeons. This technique entails an arteriotomy succeeded by closure with a textile, polymer or biological tissue patch. In this work, we propose microbuckling and microindentation as novel methodologies for acquiring the mechanical properties of patches used in carotid artery repair. Regarding microbuckling, the patch is loaded by a sensitive dynamometer at one end and its motion is recorded, at three different levels of axial deformation: δ/ℓ = 0.1, 0.3 and 0.5 (in the postbuckling regime). The corresponding experimental loads are recorded, as well. Following pertinent closed-from equations, various material metrics are obtained, such as the Young's modulus of elasticity and the so-called frictional couple of the material. Regarding microindentation, the material's hardness number is measured with the aid of a durometer. Similar to microbuckling, indentation analytical expressions allow for the determination of key material properties, such as the modulus of elasticity, indentation forces and depths. Where possible, we perform microtension to verify acquired results. Results demonstrate that measured properties may vary substantially for materials which are of the same type, due to variations of the material microstructure, as observed with optical and scanning electron microscopes (SEM). Several commercial patches were tested in this work. To shortly present the main results, the microbuckling technique furnished (for the Young's modulus) 40.17 MPa for the B/Braun Aesculap cardiovascular patch and 71.49 MPa for the Vasutek Terumo, while the microindentation technique, for bovine patches, provided 6.356 MPa for the Xeno Sure and 4.701 MPa for the Vascu-Guard. A test type recommendation is provided, relating the type of the patch material to the method more plausible in each case, in order to achieve better measurement accuracy. Results of this study can contribute in establishing guidelines and criteria determining material selection in CEA. 10% of the general population by their 8th decade and causes about 10% of all strokes [2]. Thus, carotid endarterectomy (CEA), carotid artery stenting (CAS) or best medical treatment are the current treatment options [3]. Currently, the three principal approaches to CEA are: i) primary arteriotomy closure, ii) patch angioplasty and iii) eversion CEA (eCEA). Patch angioplasty and eCEA have been more popular among vascular surgeons, in contrast to primary arteriotomy closure, because of reportedly reducing the incidence of restenosis and including theoretical technical advantages [4-7]. Carotid patch angioplasty is the most popular technique among vascular surgeons and entails a longitudinal arteriotomy which extends beyond the plaque, both proximally and distally. This is typically followed by the use of a patch angioplasty closure technique. Closure of the arteriotomy with a patch minimizes the effect of neointimal hyperplasia and scarring, maintaining the arterial lumen diameter after
Journal of Endovascular Therapy, 2018
Purpose: To present the technique for removing mural thrombus from the ascending aorta using the ... more Purpose: To present the technique for removing mural thrombus from the ascending aorta using the AngioVac System. Technique: The technique is demonstrated in a 66-year-old woman who presented with free-floating mural thrombus in the ascending aorta and was considered unsuitable for either open (comorbidities) or endovascular approaches (high risk of stroke). Because of the free-floating thrombus, the Angiovac system was suggested, although it is approved for only the venous system. The technique was adapted for the arterial system with the 2 access points being (1) the proximal left subclavian artery with a 10-mm conduit for device access and (2) the right femoral vein. The AngioVac cannula and the reinfusion cannula were inserted into the artery and vein, respectively. The extracorporeal bypass circuit was created, and the carotid arteries were clamped during aspiration (<1 minute). The mural thrombus was aspirated successfully. The patient had an uneventful postoperative course...
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Papers by Konstantinos Spanos