Nikolaos Bessias

Red Cross Hospital, Athens, Athínai, Attica, Greece

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Publications (35)45.64 Total impact

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    ABSTRACT: A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascular aortic repair (EVAR; rAAAevar) were presented to 7 referral hospitals in Greece, between January 2006 and April 2012. Type Ia endoleak and endograft migration were identified in 72.7% and 50%, respectively. Compliance to follow-up protocol prior to rupture was 31.8%. In-hospital mortality was 36.4% (9.1% for those treated with secondary EVAR and 63.6% for those treated with open surgical repair, P = .02). An increase in the proportion of patients with rAAAevar among the total number of patients with rAAAs from 1.3% in 2007 to 18.2% in 2012 (P for trend = .04) was recorded, corresponding to an annual increase of 2.8% (b = 2.84, P = .04). Rupture after EVAR seemed to be a clinical entity encountered with increasing frequency over the past years. Type I endoleak and endograft migration were most frequently observed, whereas compliance to follow-up was low. © The Author(s) 2014.
    Vascular and Endovascular Surgery 12/2014; 48(7-8). DOI:10.1177/1538574414561225 · 0.77 Impact Factor
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    ABSTRACT: Aim-Background An isolated aneurysm of the internal iliac artery is rare, but rupture has a high mortality rate, making it thus a challenging clinical entity in need of special attention as to its immediate diagnosis and treatment. Methods We present a case of ruptured isolated aneurysm of the internal iliac artery, as well as a literature review of relevant publications focusing on ruptured internal iliac artery aneurysms since 1990. Results Out of a total of 43 cases with ruptured internal iliac artery aneurysm, 37 were isolated internal iliac artery aneurysms, while in 6 cases repair of abdominal aortic aneurysm (AAA) had preceded. Abdominal pain was the most common symptom and computed tomography (CT) was the diagnostic tool in all. A rupture into another organ was reported in 10 (23%) cases; into the urinary tract (urinary bladder or ureter) in 5 (11.5%) patients, bowel in 3 (7%), and inferior vena cava in 1 (2.3%) patient. The treatment was open surgery in 18/43 cases (42%), endovascular repair in 22/43 (51%), a combination of the two methods in 2/43 (4.6%), while in one case (2.3%), there was no information regarding treatment. Death occurred in 6/43 patients (14%), 3 of whom (7%) were treated with open surgery and 3 (7%) with endovascular means. Conclusions Immediate diagnosis and treatment lead to good results, as concerns both open and endovascular repair of ruptured aneurysms of the internal iliac artery. A fundamental prerequisite is close cooperation between vascular surgeons and radiologists.
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 11/2013; 84(6). DOI:10.1007/s13126-012-0056-3
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    ABSTRACT: We sought to investigate the incidence and location of new cerebral ischemic lesions after carotid endarterectomy (CEA) using diffusion-weighted magnetic resonance imaging (DW-MRI). Sixty-six consecutive patients (50 males with a mean [±SD] age of 69 ± 9 years) who underwent CEA were included in this prospective study. Seventeen patients were symptomatic and 49 patients were asymptomatic. CEA was performed with patch closure without using a shunt. Carotid plaque echostructure was evaluated with the grayscale median (GSM) score. DW-MRI scanning of the brain was performed 24 hours before and 48 to 72 hours after the procedure. Thirty-day stroke and mortality rates were 0%. The mean GSM score for symptomatic patients was 27 ± 15; for asymptomatic patients, the mean GSM score was 39 ± 18 (P = 0.006). Patients were divided into 2 groups according to GSM score: GSM scores ≤25 (22 patients) and GSM scores >26 (44 patients). New brain lesions were detected after 6 endarterectomies (8.9%), and all were clinically silent. These lesions were ischemic in 5 cases (7.5%) and microhemorrhagic in 1 case (1.4%). In 3 cases, new ischemic lesions were located within the treated carotid artery territory. In 2 cases, new lesions on DW-MRI were located outside of the treated carotid artery territory. There was no significant difference in the incidence of ischemic lesions between the 2 groups (GSM scores ≤25, 2 lesions; GSM scores >26, 3 lesions; P = 0.544). New ischemic lesions on DW-MRI are detected in 7.5% of patients after CEA, and most of these lesions are clinically silent. Plaque echogenicity does not affect their incidence. New lesions seen on DW-MRI may be generated outside of the treated carotid artery territory.
    Annals of Vascular Surgery 06/2013; 27(7). DOI:10.1016/j.avsg.2012.10.019 · 1.03 Impact Factor
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    ABSTRACT: It is almost 6 years since Pr. Zamboni et al correlated the chronic cerebrospinal venous insufficiency syndrome (CCSVI) with multiple sclerosis (MS) and postulated that this syndrome is one the main reasons of MS. This led to a major debate within the medical community as to the existence of CCSVI, its correlation with multiple sclerosis (MS) and the hypothesis that its treatment might improve the clinical picture in patients with MS. The aim of this study is to search the literature and study the correlation of MS with CCSVI, comparing the incidence of CCSVI in patients with MS against control groups, and also to examine the results of endovascular treatment of CCVSI in patients with MS.
    05/2013; 85(3):153-159. DOI:10.1007/s13126-013-0029-1
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    ABSTRACT: Aim: Aortoenteric fistulas are a rare but often fatal cause of gastrointestinal bleeding. Operative repair has been historically associated with extremely high morbidity and mortality. From the literature and our own experience, the mean overall length of stay for patients who are successfully discharged from the hospital appears to be more than 15 days, and oral feeding is frequently delayed. Possibilities of nutritional intervention in vascular surgery patients are important. The aim of this study was to evaluate the use of parenteral nutrition in patients treated for aortoenteric fistulas.Methods: The records of all patients admitted to the Department of Vascular Surgery with AEFs during the last three years (2007–2009) were reviewed and analysed.Results: During the last three years, five patients were admitted to the Department of Vascular Surgery with AEFs. Their mean age was 55.8 years (range 49–67). Four patients were male and one was female. The mean body mass index was 28.6 kg/m2 (range 25 to 33.2). The Malnutrition Universal Screening Tool score showed a high risk for malnutrition for all the patients. The mean hospital stay was 25.2 days. All five patients were supported with total PN (four central and one peripheral). There were no complications due to PN.Conclusion: Provision of PN support in patients with AEFs may be used without complications.
    Nutrition &amp Dietetics 03/2013; 70(1-1):16–20. DOI:10.1111/j.1747-0080.2012.01634.x · 0.66 Impact Factor
  • Hippokratia 10/2012; 16(4):389. · 0.36 Impact Factor
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    ABSTRACT: Management of pseudoaneurysms in intravenous drug users poses many questions regarding need for revascularization and type of surgery. The aim of this study was to report on the frequency and management of femoral artery pseudoaneurysms in our department during the last twelve years. Retrospective report on patients hospitalized in the Department of Vascular Surgery in Red Cross Hospital, Athens, Greece between January 1999 and May 2010 with femoral artery pseudoaneurysms due to intravenous drug abuse. Overall, 23 patients (18 men, 5 women, mean age 36 years) were identified. Of these, 20 patients underwent revascularization, while femoral artery ligation had to be performed in 3. Intraoperative evaluation of leg perfusion was decisive in choice of treatment. No patient presented with critical limb ischemia postoperatively. No amputations or complications were noted during the follow-up. Treatment of common femoral artery pseudoaneurysms in drug abusers should be tailored to individual requirements. Bypass surgery is not always required, due to the pre-existing collateral network in many cases.
    International angiology: a journal of the International Union of Angiology 10/2012; 31(5):433-7. · 1.01 Impact Factor
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    ABSTRACT: Background-Aim The aim of the present study was to examine the choice of vascular access in our department during the last 3 years in comparison to other centres. Patients-Methods This report includes all patients undergoing intervention for vascular access in the Department of Vascular Surgery in Red Cross Hospital, Athens, Greece between May 2008 and May 2011. All patients were retrospectively identified and the type and anatomical location of vascular access were recorded. Results Overall, 835 patients were identified (568 men, 267 women, mean age 65.5 years) in whom 915 interventions for vascular access were carried out. AVFs were created in 152 patients; arteriovenous grafts were placed in 227 patients. We also used 163 permanent and 301 temporary CVCs. Finally, vascular access was successfully repaired in 72 patients. Conclusions Although CVCs are being increasingly used worldwide, Cimino-Brescia AVF should remain the first choice and permanent CVCs the last. In line with recent literature, permanent CVCs were used in approximately 20% of patients. This underlines the room for improvement, and should be reduced to less than 10%, in accordance with current guidelines.
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 08/2012; 84(4). DOI:10.1007/s13126-012-0036-7
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    ABSTRACT: This study reports on the frequency and management of aortocaval fistulas (ACFs) in our department between 1998 and 2009. Overall frequency of ACFs among ruptured abdominal aortic aneurysms was 5.5%. Patients presented with low back pain (92.8%), abdominal tenderness (78.6%), hemorrhagic shock (28.6%), congestive heart failure (21.4%), dyspnea (42.8%), and palpitations (57.1%). The most reliable clinical sign was the presence of palpable pulsating abdominal mass (92.8%). Other clinical findings included increased central venous pressure (21.4%), lower extremity edema (71.4%), hematuria (21.4%), and scrotal edema (14.3%). Diagnosis was established preoperatively in 85.7% and intraoperatively in 14.3% of cases. Surgery was successful in promptly improving clinical signs and symptoms. Mortality rate was 7.1%. After a mean follow-up of 18.5 months, all surviving patients remained free from complications. In conclusion, ACFs represent a life-threatening emergency for vascular surgeons but can be successfully managed.
    Vascular and Endovascular Surgery 02/2012; 46(1):26-9. DOI:10.1177/1538574411418842 · 0.77 Impact Factor
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    ABSTRACT: ABSTRACT: The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1st January 2009 and 31st December 2010. Overall, 2452 (49.4%) out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6%) needed vascular surgical intervention. The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.
    BMC Research Notes 11/2011; 4:481. DOI:10.1186/1756-0500-4-481
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    ABSTRACT: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.
    European journal of radiology 07/2011; 81(9):2270-2. DOI:10.1016/j.ejrad.2011.06.025 · 2.65 Impact Factor
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    ABSTRACT: Background-AimCentral venous catheters (CVC) can be used for mid and long-term venous access allowing administration, monitoring and haemodialysis. The objective of our study is to compare the complications from the insertion of dialysis CVC to those arising from insertion of CVC for other use. Materials and MethodsWe retrospectively evaluated the positioning of 285 dual lumen 12Fr CVCs for haemodialysis [Group P1] and 520 three lumen 6Fr catheters [Group P2] from January 2008 to February 2010. All CVCs were positioned by our vascular access team. We compared vein selection, efficacy in positioning, early and late complications. ResultsIn both groups, the subclavian vein was principally chosen for catheterization. Positioning failed in 7 patients group (P1), while in P2 all CVCs were positioned successfully. Early complications presented in 9 patients from group (P1) (3.1%) and in 12 from group P2 (2.3%). In group P1, 4 cases of CVC-related infection were reported for every 1000 days of use as opposed to 15 cases in group P2. ConclusionsThe diverse types of CVC devices involve comparable rates of complications; although the larger diameter of dialysis catheters reduces the risk of malposition, it increases the rate of site injuries. Fewer late complications were reported for dialysis catheters, which may be attributed to their highly specialized use. Key wordsCentral venous catheter–Haemodialysis catheter
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 06/2011; 83(3):121-125. DOI:10.1007/s13126-011-0025-2
  • The journal of vascular access 11/2010; 11(4):364. DOI:10.5301/JVA.2010.6017 · 1.02 Impact Factor
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    ABSTRACT: According to current international guidelines, patients with infrarenal or juxtarenal abdominal aortic aneurysms (AAAs) measuring > or = 5.5 cm should undergo repair to reduce the risk of rupture. The 5.5-cm-diameter threshold is the size when the AAA rupture rate balances the mortality rates of elective open surgical AAA repair (3%). Endovascular AAA repair (EVAR) is associated with lower perioperative mortality and complication rates compared with open surgical repair. This debate addresses the issue whether the current size threshold for elective AAA repair needs to be lowered in the endovascular era. This paper supports the position that the size threshold for AAA repair should be lowered in the endovascular era.
    Angiology 10/2010; 61(7):617-9. DOI:10.1177/0003319710375084 · 2.37 Impact Factor
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    ABSTRACT: To determine the effect of the duration of aortic cross-clamping during elective infrarenal abdominal aortic aneurysm (AAA) repair operations on postoperative cardiac and renal function. Fifty patients scheduled for open infrarenal AAA repair underwent pre- and postoperative evaluation of serum creatinine and troponin levels. The patients were divided into 2 groups according to the duration of aortic cross-clamping (Group A: <50 min; Group B: >50 min). A prolonged (>50 min) duration of aortic cross-clamping was associated with an increase in post-operative serum troponin (P<0.001) and serum creatinine values (P<0.001). A prolonged duration of aortic cross-clamping was the only independent predictor of postoperative renal (r=0.534; P<0.001) and cardiac dysfunction (r=0.578; P<0.001). Elective open infrarenal AAA repair procedures may be associated with mild/moderate cardiac and/or renal dysfunction, especially when aortic cross-clamping time is prolonged. Measuring serum troponin and creatinine levels before and after such operations may reveal an often clinically-silent post-operative cardiac and/or renal dysfunction.
    International angiology: a journal of the International Union of Angiology 06/2010; 29(3):244-8. · 1.01 Impact Factor
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    ABSTRACT: Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is associated with lower 30-day mortality rates compared with open repair. Despite that, there are no significant differences in mortality rates between the two procedures at 2 years. On the other hand, EVAR is associated with considerably higher costs compared with open repair. The lack of significant long-term differences between the two procedures together with the substantially higher cost of EVAR may question the appropriateness of EVAR as an alternative to open surgical repair in patients fit for surgery. With several thousands of AAA procedures performed worldwide, the employment of EVAR for the management of all AAAs irrespective of the patient's surgical risk may hold implications for several national health economies. The lower perioperative mortality and morbidity rates associated with EVAR should thus be counterbalanced against the considerable costs of these procedures.
    Vascular and Endovascular Surgery 02/2010; 44(4):319-20. DOI:10.1177/1538574410362119 · 0.77 Impact Factor
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    ABSTRACT: This report presents a case of type II endoleak after endovascular exclusion of a primary aortocaval fistula, producing renal vein hypertension and renal insufficiency. A 74-year-old patient presented with acute renal insufficiency, hematuria, lower limb edema, and weight gain. The abdominal CT scan revealed an abdominal aortic aneurysm and an aortocaval fistula. An endograft was deployed but type II endoleak was present and persisted after surgical ligation of the inferior mesenteric artery and subsequent unsuccessful attempt of coil-embolization. The patients renal function continued to be impaired. Surgical ligation of aortocaval communication with preservation of the endograft was performed, resulting in restored renal function.
    VASA.: Zeitschrift für Gefässkrankheiten. Journal for vascular diseases 02/2010; 39(1):98-102. DOI:10.1024/0301-1526/a000011 · 1.21 Impact Factor
  • Internal Medicine 01/2010; 49(2):199-200. DOI:10.2169/internalmedicine.49.2756 · 0.97 Impact Factor
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    International Urology and Nephrology 12/2009; 42(2):523-5. DOI:10.1007/s11255-009-9691-1 · 1.29 Impact Factor
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    ABSTRACT: The main clinical criterion for abdominal aortic aneurysm (AAA) repair operations is an AAA diameter >/=5.5 cm. When AAAs increase in size, specific changes occur in the mechanical properties of the aortic wall. Pulse-wave velocity (PWV) has been used as an indicator of vascular stiffness. A low PWV may predict AAA rupture risk and is an early predictor of cardiovascular mortality. We investigated the prognostic value of PWV before and after elective AAA repair procedures. Twenty four patients scheduled for an open AAA repair underwent a preoperative carotid-femoral aortic PWV measurement. A second aortic PWV measurement was carried out 6 months postoperatively. The mean aortic PWV increased from 7.84 +/- 1.85 preoperatively to 10.08 +/- 1.57 m/sec 6 months postoperatively (mean change: 2.25; 95% confidence interval 1.4 to 3.1 m/sec; p<0.0001). The preprocedural PWV measurement did not correlate with AAA diameter (Spearman's rank correlation coefficient rho=0.12; p=0.59). Whether the increase in aortic PWV postoperatively suggests a decreased cardiovascular risk following AAA repair remains to be established. Aortic PWV should also be investigated as an adjunct tool for assessing AAA rupture risk.
    The Open Cardiovascular Medicine Journal 12/2009; 3(1):173-5. DOI:10.2174/1874192400903010173