Thomas J Holzenbein

Medical University of Vienna, Wien, Vienna, Austria

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Publications (10)12.22 Total impact

  • Journal of Vascular Surgery 06/2011; 53(S):17S. · 2.88 Impact Factor
  • Journal of Vascular Surgery - J VASC SURG. 01/2011; 53(6).
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    ABSTRACT: We report on the case of a 35-year-old male who underwent emergency stent-graft placement in March 2007 due to a complicated type B dissection. One week after this procedure the patient developed critical visceral malperfusion. Subsequently, autologous iliaco-mesenteric as well as iliaco-hepatic bypass grafting was performed. At 6-month follow-up, aortic remodelling has occurred and visceral perfusion is regular.
    The Thoracic and Cardiovascular Surgeon 04/2009; 57(2):110-1. · 0.93 Impact Factor
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    ABSTRACT: Pedal bypass failure is not always associated with limb loss. Management of critical limb ischemia after failure is controversial. The aim of this study is to evaluate the results of redo bypass procedures to foot arteries in the absence of alternative tibial outflow arteries. Data of patients undergoing redo pedal bypass within a 14-year period were reviewed. The outcome after redo pedal bypass in patients whose original pedal bypass failed within 30 days versus those in patients whose original pedal bypass failed more than 30 days after the original pedal bypass were reviewed. Society for Vascular Surgery reporting standards were applied. Out of 335 pedal bypass grafts, 22 (6.6%) pedal redo bypass procedures were identified in 20 patients performed after previous pedal graft failure: 64% were male, mean age 67.7 +/- 9.5 years, diabetes 90.9%, hypertension 90.9%, coronary disease 68.2%, renal disease 18.2%. Seven patients were operated for early failure and 15 for late failure (median 193 days). The graft conduit at the first operation was ipsilateral greater saphenous vein (GSV) in 18 (81.8%), alternative vein in three (13.6%), and one expanded polytetrafluoroethylene. Redo graft conduits were as follows: ipsilateral GSV in nine (40.9%), arm vein in six (27.3%), contralateral GSV in two (9.1%), "other veins" in two (9.1%), and homologous artery in three (13.6%). The same target artery was used in 81.8%, at the initial site in 54.5% and more distally in 27.3%. Redo revascularization for early failure was successful only once. Median follow-up after late redo was 23.7 months. Seven redo grafts performed after late pedal graft failure failed after a median of 115 days. The availability of adequate autologous conduit is the limiting factor for redo procedures. Lack of alternative outflow sites adds to the difficulty of target artery dissection. Redo pedal bypass surgery after early pedal bypass failure is associated with very poor patency and limb salvage. Acceptable patency and extension of limb salvage can be achieved with redo procedures for late pedal bypass failure.
    Annals of Vascular Surgery 12/2007; 21(6):713-8. · 0.99 Impact Factor
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    ABSTRACT: L'échec d'un pontage pédieux n'est pas toujours associé à la perte du membre. La gestion de l'ischémie critique après échec de pontage est controversée. Le but de cette étude est d'évaluer les résultats des pontages itératifs sur les artères du pied en l'absence d'artère jambière utilisable. Les dossiers des patients ayant un pontage itératif sur les artères du pied au cours d'une période de 14 ans ont été revus. Les résultats des patients dont le pontage initial a échoué dans les 30 jours suivant la chirurgie initiale et ceux des patients dont le pontage initial a échoué plus de 30 jours après que l'intervention initiale ont été revus. Les standards de la Society for Vascular Surgery ont été appliqués. Sur 335 pontages sur les artères du pied, 22 (6,6%) pontages itératifs ont été identifiés chez 20 patients réalisés après échec d'un précédent pontage au pied : 64% étaient des hommes, d'un âge moyen de 67,7 ± 9,5 ans, 90,9% diabétiques, 90,9% hypertendus, 68,2% coronariens, 18,2% insuffisants rénaux. Sept patients ont été opérés pour échec précoce et 15 pour échec tardif (médiane 193 jours). Le substitut lors de la première intervention était la veine grande saphène homolatérale (VGS) dans 18 cas (81,8%), une autre veine chez trois (13,6%), et un polytétrafluoroéthylène expansé. Les substituts des réinterventions étaient : VGS homolatérale dans neuf cas (40,9%), veines du bras dans six cas (27,3%), VGS controlatérale dans deux cas (9,1%), « autres veines » dans deux cas (9,1%), et artère homologue dans trois cas (13,6%). La même artère cible a été employée dans 81,8% des cas, au site initial dans 54,5% des cas et d'une manière plus distale dans 27,3% des cas. La revascularisation pour échec précoce n'a réussi qu'une fois. Le suivi médian après réintervention tardive était de 23,7 mois. Sept pontages effectués après échec tardif de pontage pédieux ont échoué après une médiane de 115 jours. La disponibilité d'un substitut autologue adapté est le facteur de limitation des procédures itératives. Le manque de site receveur alternatif ajoute à la difficulté de la dissection d'une artère cible. La chirurgie itérative après échec précoce de pontage pédieux est associée à une perméabilité et à un sauvetage de membre très faible. Une perméabilité et une prolongation du sauvetage de membre acceptables peuvent être obtenues avec les procédures itératives pour échec tardif de pontage pédieux.
    Annales De Chirurgie Vasculaire. 01/2007; 21(6):350-356.
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    ABSTRACT: Endovascular stent-graft placement is an accepted treatment for various diseases of the thoracic aorta. However, visceral rerouting, in order to gain sufficient distal length to safely deploy the stent-graft in patients with distal aneurysm extension, has not been reported often in the literature.We report on the case of an 82-year-old patient with two aneurysms of the descending aorta and involvement of the celiac trunk. The patient was treated by an autologous renal to hepatic artery bypass and consecutive stent-graft placement.In selected patients, extraanatomic visceral bypass and consecutive stent-graft placement can be a less invasive alternative to conventional approaches.
    EJVES Extra 03/2006; 31(5):564-564.
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    ABSTRACT: Endovascular stent-graft placement has become a safe and effective treatment modality for various diseases of the distal aortic arch as well as of the descending aorta. However, its effectiveness may be limited by various kinds of endoleaks resulting in persistent or recurrent perfusion of the aneurysm sac. Subsequently, systemic pressurization leads to expansion of the aneurysm sac, exposing the patient to a recurrent risk of aneurysm rupture. We report on the case of a 57-year-old male who underwent emergency stent-graft placement in March 2001 due to a contained rupture of a distal aortic arch aneurysm involving the origin of the left subclavian artery. Due to the emergency condition, a subclavian-to-carotid artery transposition had not been performed prior to stent-graft placement. During follow-up the patient developed a type II endoleak originating from the left subclavian artery with consecutive enlargement of the aneurysm sac. The endoleak was successfully treated by subclavian-to-carotid artery transposition.
    The Thoracic and Cardiovascular Surgeon 11/2005; 53(5):322-4. · 0.93 Impact Factor
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    ABSTRACT: Although the utility of dorsalis pedis (DP) bypass for limb ischemia has been well established, the fate of limbs with a failed bypass to the DP artery remains unclear. Data of all patients undergoing DP bypass grafting within a 12-year period from two university hospitals' vascular registries were retrospectively reviewed. Outcomes of early (<30 days) and delayed graft failure (>30 days) were examined. The Student's t-test and chi-squared test were used for univariate analysis; patency rates and patient survival were calculated using the Kaplan-Meier product limit method. Of 1434 DP bypass grafts, 277 (19.3%) failed grafts were identified. Sixty five (4.5%) grafts failed early (within 30 days of surgery) and 212 (14.8%) failed late at a mean time of 15.3 months (range, 1.5-105 months) after initial bypass. Of the 65 limbs with early graft failure, 28 (43.1%) proceeded directly to amputation and 20 underwent additional revascularization attempts, but limb salvage was achieved in only 7 patients; in 45 (69.2%) patients no further revascularizations were attempted. Seventy-four (34.9%) patients with late graft failure underwent redo revascularization. Thirty-nine (52.6%) had their limb saved with graft revision, but 35 patients (47.3%) ultimately lost their limb. In 138 patients with late graft failure (65.1%) no further revascularization attempts were performed. Sixty-two (44.9%) required major amputation. Overall, 49.8% of patients with failed pedal grafts ultimately suffered limb loss. Early graft failure resulted in a significantly higher rate of major amputation that did late graft failure (63.1% vs. 45.8%, respectively; p = 0.015). These results indicate that early occlusion of pedal bypass often leads to immediate major amputation and interventions to maintain graft patency in this setting are often futile. Late failure of pedal bypass is associated with a lower likelihood of amputation because of a higher rate of success of bypass revisions and a lower occurrence of critical ischemia with graft failure.
    Annals of Vascular Surgery 01/2005; 19(1):56-62. · 0.99 Impact Factor
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    ABSTRACT: To evaluate the feasibility and long-term outcome of distal arterial reconstruction combined with free muscle flap transfer for patients who would otherwise have undergone major amputation. Between 1996 and 2001, 27 reconstructions using autologous vein were performed in 25 patients. Seventeen of these patients had diabetes mellitus. Gracilis, rectus abdominis and latissimus dorsi muscles were used as free flaps, covered with split-thickness skin grafts. Eighty-five percent of patients had a patent graft and viable muscle flap after 1-month. Mean follow-up was 51 months (4-72 months). At the time of follow-up 77% of reconstructions were patent and 70% of patients regained full functional capacity of their lower extremities. Limb-salvage by distal arterial reconstruction and free muscle flap transfer, is feasible with low mortality and morbidity and provides excellent long-term results with regard to graft patency and functional status.
    European Journal of Vascular and Endovascular Surgery 07/2004; 27(6):635-9. · 2.82 Impact Factor
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    ABSTRACT: To determine midterm durability and need for reinterventions after stent-graft placement in atherosclerotic descending thoracic aortic aneurysms. Fifty-four patients (38 men; mean age 68 years, range 33-87) underwent stent-graft repair of chronic atherosclerotic aneurysms of the descending thoracic aorta between November 1996 and December 2002. Acute aortic syndromes (type B aortic dissections, perforating ulcers, and traumatic dissections) were excluded from analysis. Two types of commercially available stent-grafts were used (Talent and Excluder). The primary technical success rate was 94.4%. In-hospital mortality was 3.7% (2/54). No adverse neurological events were encountered. Of 3 (5.6%) early type I endoleaks, 2 (3.7%) required reintervention; the other type I endoleak closed spontaneously. Mean follow-up was 38 months (range 1-72) in the 52 surviving patients. Four (7.7%) type I, 7 (13.5%) type II, and 4 (7.7%) type III endoleaks were seen. Three 3 patients had additional treatment for endoleaks (proximal stenting [type Ia], open thoracoabdominal repair [type Ib], and embolization [type II]). Two of the 3 reinterventions were performed in the first year of follow-up. One additional patient with a type Ia endoleak not suitable for reintervention is under close observation. There were no differences in the number of endoleaks between the 2 types of stent-grafts. Three-year event-free survival was 63%. Midterm durability of endovascular stent-graft placement in atherosclerotic descending aortic aneurysms seems promising, as the rate of endoleaks requiring reintervention is acceptably low. In our series, endoleak formation occurred during the first year after stent-graft placement, so close follow-up of patients after aortic aneurysm repair is crucial. Further studies are warranted to evaluate long-term durability of this new treatment modality.
    Journal of Endovascular Therapy 03/2004; 11(1):26-32. · 2.70 Impact Factor