A Megalopoulos

Aristotle University of Thessaloniki, SalonĂ­ki, Central Macedonia, Greece

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Publications (14)11.31 Total impact

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    ABSTRACT: The treatment of ruptured abdominal aortic aneurysms is a constant challenge for vascular surgeons and can be achieved either by endovascular repair or by an open surgical technique. Endovascular repair presents a higher 30-day survival rate. The aim of this study was to compare the clinical and anatomical characteristics and the outcomes of these two treatment techniques. Our study sample comprised patients who presented at the emergency department of a General Regional Hospital with rupture of an abdominal aortic aneurysm between January 2003 and December 2008. Of the 43 patients who were treated, 23 underwent open surgical repair and 20 underwent endovascular repair. Comorbidities, age, clinical presentation and anatomical characteristics didn't present statistically significant differences in the two groups. Patients in the endovascular repair group were transfused with less units of blood and fresh frozen plasma (P=0.001) and had shorter stay in the intensive care unit (P=0.042). The 30-day mortality rate was 43% for open surgical repair and 35% for endovascular treatment (P=0.627), while the overall in-hospital mortality rate was 61% and 50% (P=0.474), respectively. When certain anatomical characteristics are present and the hemodynamic condition of the patient allows it, endovascular treatment appears to be associated with better survival rates, both 30-day and overall.
    International angiology: a journal of the International Union of Angiology 08/2012; 31(4):386-92. · 1.46 Impact Factor
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    ABSTRACT: The authors present the case of a 39-year-old man who underwent endovascular repair of a thoracic aortic disruption. Implantation of a Gore TAG stent-graft achieved total exclusion of the traumatic lesion with no contrast extravasation. However, on the third postoperative day, the patient developed complete anuria necessitating continuous venovenous hemofiltration. On the IV postoperative day there were no palpable femoral pulses and the pressure gradient between the lower and upper limbs was -80 mmHg. Given the development of severe intestinal and peripheral hypoperfusion status a possible endograft collapse was suspected. Urgent computed tomography (CT) angiography demonstrated central subtotal collapse of the device and proper distal sealing. A second TAG stent-graft was deployed successfully within the collapsed device with no contrast extravasation and good apposition of the stent-graft to the aortic wall. At 6 months, there is no sign of graft collapse or endoleak. Endovascular reintervention succeeded re-expansion of the collapsed endoprosthesis and resolution of the initial symptoms.
    Minerva chirurgica 09/2009; 64(4):431-6. · 0.39 Impact Factor
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    ABSTRACT: The short saphenous vein can be used "in situ" to create a temporary arteriovenous shunt for lengthening the recipient vessels of the injured limb in microsurgical reconstructions of the lower extremity. We report our results using this single-anastomosis turnover technique in three high-energy trauma patients who presented open tibial fractures associated with vascular injuries. The construction of the arteriovenous fistula provided arterial access and venous drainage to a free latissimus dorsi flap that was transferred to cover the soft tissue defect. In all three cases, this single stage procedure was successful; the flap survived and provided good long term results. The use of the ipsilateral small saphenous vein "in situ" for immediate arteriovenous loop formation may be of great value in complex lower leg reconstructions. It is a reliable adjunctive technique that provides healthy vessels to supply the free flap, permitting stable wound coverage and high rate of limb salvage.
    Archives of Orthopaedic and Trauma Surgery 11/2008; 129(4):521-4. · 1.36 Impact Factor
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    ABSTRACT: Penetrating atherosclerotic ulcer (PAU) of infrarenal aorta is a rare but life-threatening entity affecting elderly patients with severe atherosclerotic disease, and potentially complicated with intramural hematoma, adventitial pseudoaneurysm or aortic rupture. Although open surgical repair is an effective therapeutic option, endovascular treatment is emerging as an attractive alternative, especially in high-risk elderly patients.We report our experience with four cases of endovascular stent-grafting of infrarenal aorta PAU. All patients presented with abdominal or lumbar pain, and two of them with shock. The diagnosis was based on CT scan and angiography that demonstrated infrarenal pseudoaneurysm in two and focal nonaneurysmal infrarenal aortic rupture in the other two patients, secondary to PAU. Endoluminal transfemoral stent-grafting was successfully delivered in all patients. One of them died 5 days after the intervention because of multiple organ failure. During a mean follow-up period of 24 months, no endoleak, aneurysm evolution or stent-graft failure were found in the remaining three patients.
    EJVES Extra 01/2008; 16(1):4-9.
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    ABSTRACT: To evaluate the reliability of selective surveillance colonoscopy based on 6 specific perioperative risk factors in the early diagnosis of colonic ischemia (CI) after successful ruptured abdominal aortic aneurysm (rAAA) repair. From 1999 to 2005, 62 consecutive patients underwent rAAA repair. In 59 of them, routine aggressive surveillance colonoscopy was offered every 12 hours within the first 48 hours, and CI was graded consistently. Patients with stage I or stage II CI were treated conservatively and were followed up with repeat colonoscopy, whereas patients with stage III CI underwent immediate laparotomy and colectomy. In parallel, 6 specific perioperative risk factors (PRFs) were retrospectively analyzed. Overall mortality was 33.9%. Nineteen patients (32.2%) developed CI and 12 (63.2%) of them survived. Thirteen (22%) had grade III CI and among these 6 survived. In patients with CI the mortality rate was 36.2%. Patients with less than 3 PRFs had no CI whereas all instances of CI could be diagnosed if colonoscopy was offered selectively in patients with more than 3 PRFs. The positive predictive value of CI increased with the number of PRFs. Patients with 5 or 6 PRFs were about 101 times more likely to develop CI compared with patients with 0 to 4 PRFs (P<.001). Our study showed that CI is a frequent complication after successful rAAA repair and could reliably be early diagnosed if surveillance colonoscopy was offered selectively in patients with more than three PRFs.
    Vascular and Endovascular Surgery 01/2008; 41(6):509-15. · 0.88 Impact Factor
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    ABSTRACT: The of this study is to present our experience in the management of patients with Altemeier-Klatskin tumor, with particular focus on the risk factors that influence survival after tumor resection. Over a 15-year period, 37 patients with hilar cholangiocarcinoma were managed in our Department. The mean age of the patients was 62.5 years. Twenty-one patients were treated by palliative measures while sixteen patients had resection of the tumor and 11 of these had negative histological margins. An associated major hepatectomy was performed in six. In parallel, certain risk factors that could influence survival were analyzed. The resectability rate was 43.2%. The 30-day mortality rate was 7.4% and postoperative morbidity was 37.5%. The sites of the resected tumors were Bismuth-Corlette type I lesions in 3 patients, type II in 6, type IIIa in 2, and type IIIb in 5. The median survival of patients undergoing resection was significantly higher than of patients not undergoing resection (p<0.001). Furthermore, patients with R0 resection and histological clear margins experienced significantly superior survival than patients with R1 resection and positive margins (p=0.001, and p<0.001 respectively). Resections resulting in cancer-positive margins did not portend a survival benefit. Negative surgical margins, tumor differentiation and infiltrating macroscopic appearance, were statistically significant prognostic factors. Our findings emphasize that complete resection of the tumor with negative histological margins offers the best possibility of long-term survival, and that the addition of hepatectomy to biliary resection results in a greater number of patients with margin negative resections.
    Journal of gastrointestinal and liver diseases: JGLD 12/2007; 16(4):383-9. · 1.86 Impact Factor
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    ABSTRACT: The aim of our study is to present our experience in the surgical treatment of nonfunctioning pancreatic endocrine tumors (NFPETs) in patients with multiple endocrine neoplasia type 1 (MEN-1). Between 1996 and 2006 a total of 11 patients with clinically confirmed MEN 1 syndrome were monitored in an annual screening program that included evaluation of the pancreas. Our policy was to use Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasound (EUS) in combination with biochemical screening in an effort to early diagnose and categorize the pancreatic involvement in MEN-1. NFPETs were identified in 4 female patients (36.4%). Diagnosis of NFPET was established 4.2 years later than that of MEN 1. The median tumor diameter at diagnosis was 2.2 cm (range 1.8-2.6 cm). All patients were treated by distal pancreatectomy. Diagnosis of NFPET was established in histological sections by staining with neuroendocrine tumor markers. Adjuvant therapy with streptozocin in combination with 5-fluorouracil was applied in two patients. After surgery the patients were followed up annually with clinical evaluation, biochemical tests and imaging studies. Early detection of NFPETs in patients with MEN-1 syndrome can be accomplished by biochemical and radiological screening program. NFPETs should be removed when diagnosed, in order to achieve a timely and efficient prophylaxis against further tumor growth and malignant development.
    Journal of gastrointestinal and liver diseases: JGLD 10/2007; 16(3):257-62. · 1.86 Impact Factor
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    ABSTRACT: Pseudoaneurysms of the popliteal artery (PPA) rarely occur in children. In fact, we found only 10 cases reported in the medical literature. We report the case of a 4-year-old boy who presented with a painful palpable mass in the right popliteal fossa. He also had mild, painless right foot-drop and difficulty toe-walking on the same side. The diagnosis of a PPA was based on the findings of triplex ultrasound and computed tomographic-angiography. We attributed the cause of the lesion to blunt trauma, which he had suffered 2 years earlier. Thorough preoperative evaluation excluded the possibility of a self-immune process or a bone tumor in the region. Neurological examination demonstrated a mild, isolated, peripheral mononeuropathy of the right peroneal nerve. Thus, we performed surgical repair using an autologous reversed great saphenous vein graft. The patient had an uneventful postoperative course and his peripheral neuropathy and foot-drop resolved completely within 1 month after surgery. Now, after 3 years of follow-up, the patient has a patent graft and a fully functioning limb. PPAs are rare, especially in children, and trauma is the predominating underlying cause. PPAs should be treated immediately after diagnosis because their complications are associated with high rates of functional impairment and even limb loss.
    Surgery Today 02/2007; 37(9):798-801. · 0.96 Impact Factor
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    ABSTRACT: In its more severe form heparin induced thrombocytopenia (HIT) is a rare immune mediated complication of heparin administration that potentially has catastrophic results, and significant mortality. In view of the severity of this condition it is important for the clinician to maintain a high index of suspicion and get alerted to the HIT syndrome by the precocity of platelet count decrease in any patient group, and especially in those previously exposed to heparin. We report on a 72-year-old woman who developed HIT syndrome that was complicated by recurrent arterial thromboses after receiving postoperative antithrombotic prophylaxis with tinzaparin, a low molecular weight heparin. The patient was successfully treated with iloprost (Ilomedin, iloprost tromethamine, Schering) a stable prostacyclin analogue, at the acute phase of the syndrome, followed by long-term treatment with clopidogrel (Plavix, clopidogrel bisulfate, Sanofi) an inhibitor of adenosine diphosphate (ADP) receptor. Although direct thrombin inhibitors have been proven to be effective for the treatment of HIT thrombosis, they do not completely eliminate the morbidity and mortality of this disorder. Our case report suggests that antithrombotic treatment by targeting of the activated platelets with a potent platelet inhibitor during the acute phase of type II HIT syndrome followed by long-term administration of oral anticoagulation may be an additional, safe and effective therapeutic alternative that merits to be systematically studied.
    International angiology: a journal of the International Union of Angiology 04/2006; 25(1):84-9. · 1.46 Impact Factor
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    ABSTRACT: To report our early experience with endovascular treatment of symptomatic and ruptured abdominal aortic aneurysms (AAA) using the Talent bifurcated stent graft. From August 2003 to May 2007 nine patients with symptomatic AAA (sAAA) (two after previous endovascular repair and endoleak), and eleven patients with ruptured AAA (rAAA) (one with ruptured iliac aneurysm and one with spontaneous aortic rupture) were treated endovascularly. Seven bifurcated stent grafts, (six Talent), and two iliac extensions were implanted into the patients with sAAA, and nine bifurcated stent grafts (eight Talent) and two aorto-uniliacs were implanted into the patients with rAAA. The deployment of the endovascular device in the intended location was successful in all patients. There was no conversion to open surgery. One patient with sAAA died after stroke and sepsis resulting in 11.1% 30-day mortality in this group. One required re-intervention for a type I endoleak before his discharge. Eight patients were discharged and during a follow-up period of 4-42 months (median 18 months) they have remained well. Two patients with rAAA died in the 30-day postoperative period. Thirty-day mortality was 18.1%. An unintended occlusion of one renal artery was performed. There were 9 survivors. During a follow-up period of 17-45 months (median 26 months) one more died of myocardial infarction. Initial experience with endovascular treatment of patients with symptomatic or ruptured AAA, using the Talent bifurcated stent graft is promising. Bifurcated endografts can be implanted into patients with rAAA. A larger number of patients and longer follow-up is necessary to arrive at more reliable conclusions.
    Acta chirurgica Belgica 01/2006; 109(3):327-32. · 0.36 Impact Factor
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    ABSTRACT: Penetrating atherosclerotic ulcer (PAU) of the infrarenal aorta is rare and occurs when an atherosclerotic plaque ulcerates through the intima. PAU can be complicated by the development of intramural hematoma, adventitial pseudoaneurysm, and rupture. We report two cases that were treated by endovascular stent-graft placement and discuss the literature.
    EJVES Extra 01/2005; 9(4):63-65.
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    ABSTRACT: We report a case of an 85-year-old man with true isolated bilateral superficial femoral artery aneurysms. The aneurysm size was 6.2cm on the right and 4.8cm on the left. They were repaired with transfemoral endovascular placement of three excluder stent grafts on the right and two excluder stent grafts on the left. Both procedures were done under local anesthesia.
    EJVES Extra 01/2005; 9(5):111-112.
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    ABSTRACT: A true para-anastomotic right common iliac artery aneurysm and intermittent claudication developed in a 76-year-old man 5 years after open abdominal aortic aneurysm repair with a Dacron tube graft. Following the initial operation the patient developed acute left iliac occlusive disease necessitating an immediate right-to-left femoro-femoral crossover bypass graft. The patient was a poor open surgical candidate because of multiple medical comorbidities. Therefore, a hybrid approach was used consisting of exposure and catheterization of the right profunda femoris artery, which was used as the access site vessel for the deployment of a covered stent graft extending from the ostium of the common iliac artery into the external iliac artery. Simultaneously, the right profunda femoris provided inflow for an open above-knee profunda femoro-popliteal bypass graft to perfuse the right lower extremity. Postoperative angiography demonstrated primary technical success, with exclusion of the aneurysm and no endoleak. The patient is doing well 34 months postoperatively, with a patent endograft and no sign of intermittent claudication. Profunda femoris proved to be an excellent alternative to the common femoral artery for the application of a hybrid technique in a high-risk patient with complicated anatomy.
    Acta chirurgica Belgica 109(6):791-6. · 0.36 Impact Factor
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    ABSTRACT: We present the case of a 61-year-old woman who underwent repair of a symptomatic 4-cm splenic artery aneurysm. This patient had received heart transplantation for hypertrophic congestive cardiomyopathy 5 years before this event. She was under immunosuppression therapy with cyclosporine, prednisone and azathioprine. The aneurysm was ligated both proximally and distally without removal of the spleen. To our knowledge, this is the first reported case of an isolated splenic artery aneurysm in the heart transplant population. We discuss the potential role of immunosuppressive agents and hormonal factors in the development of this extremely rare occurrence.
    Acta chirurgica Belgica 110(3):328-31. · 0.36 Impact Factor