Nicos Labropoulos

Stony Brook University Hospital, Stony Brook, New York, United States

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Publications (234)481.73 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A mathematical approach of blood flow within an abdominal aortic aneurysm (AAA) with intraluminal thrombus (ILT) is presented. The macroscale formation of ILT is modeled as a growing porous medium with variable porosity and permeability according to values proposed in the literature. The model outlines the effect of a porous ILT on blood flow in AAAs. The numerical solution is obtained by employing a structured computational mesh of an idealized fusiform AAA geometry and applying the Galerkin weighted residual method in generalized curvilinear coordinates. Results on velocity and pressure fields of independent cases with and without ILT are presented and discussed. The vortices that develop within the aneurysmal cavity are studied and visualized as ILT becomes more condensed. From a mechanistic point of view, the reduction of bulge pressure, as ILT is thickening, supports the observation that ILT could protect the AAA from a possible rupture. The model also predicts a relocation of the maximum pressure region toward the zone proximal to the neck of the aneurysm. However, other mechanisms, such as the gradual wall weakening that usually accompany AAA and ILT formation, which are not included in this study, may offset this effect.
    Computer Methods in Biomechanics and Biomedical Engineering 01/2015; · 1.79 Impact Factor
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    ABSTRACT: Cost containment is the cornerstone of the Affordable Care Act. Although studies have compared the cost of cerebral aneurysm clipping (CAC) and coiling, they have not focused on identification of drivers of cost after CAC, or prediction of its magnitude. The objective of the present study was to develop and validate a predictive model of hospitalization cost after CAC. We performed a retrospective study involving CAC patients who were registered in the Nationwide Inpatient Sample (NIS) database from 2005 to 2010. The two cohorts of ruptured and unruptured aneurysms underwent 1:1 randomization to create derivation and validation subsamples. Regression techniques were used for the creation of a parsimonious predictive model. Of the 7798 patients undergoing CAC, 4505 (58%) presented with unruptured and 3293 (42%) with ruptured aneurysms. Median hospitalization cost was US$24 398 (IQR $17 079 to $38 249) and $73 694 (IQR $46 270 to $115 128) for the two cohorts, respectively. Common drivers of cost identified in the multivariate analyses included the following: length of stay, number of admission diagnoses and procedures, hospital size and region, and patient income. The models were validated in independent cohorts and demonstrated final R(2) values very similar to the initial models. The predicted and observed values in the validation cohort demonstrated good correlation. This national study identified significant drivers of hospitalization cost after CAC. The presented model can be utilized as an adjunct in the cost containment debate and the creation of data driven policies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Journal of Neurointerventional Surgery 01/2015; · 2.50 Impact Factor
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    ABSTRACT: Rupture of abdominal aortic aneurysm (AAA) is associated with high mortality rates. Risk of rupture is multi-factorial involving AAA geometric configuration, vessel tortuosity, and the presence of intraluminal pathology. Fluid structure interaction (FSI) simulations were conducted in patient based computed tomography scans reconstructed geometries in order to monitor aneurysmal disease progression from normal aortas to non-ruptured and contained ruptured AAA (rAAA), and the AAA risk of rupture was assessed. Three groups of 8 subjects each were studied: 8 normal and 16 pathological (8 non-ruptured and 8 rAAA). The AAA anatomical structures segmented included the blood lumen, intraluminal thrombus (ILT), vessel wall, and embedded calcifications. The vessel wall was described with anisotropic material model that was matched to experimental measurements of AAA tissue specimens. A statistical model for estimating the local wall strength distribution was employed to generate a map of a rupture potential index (RPI), representing the ratio between the local stress and local strength distribution. The FSI simulations followed a clear trend of increasing wall stresses from normal to pathological cases. The maximal stresses were observed in the areas where the ILT was not present, indicating a potential protective effect of the ILT. Statistically significant differences were observed between the peak systolic stress and the peak stress at the mean arterial pressure between the three groups. For the ruptured aneurysms, where the geometry of intact aneurysm was reconstructed, results of the FSI simulations clearly depicted maximum wall stress at the a priori known location of rupture. The RPI mapping indicated several distinct regions of high RPI coinciding with the actual location of rupture. The FSI methodology demonstrates that the aneurysmal disease can be described by numerical simulations, as indicated by a clear trend of increasing aortic wall stresses in the studied groups, (normal aortas, AAAs and rAAAs). Ultimately, the results demonstrate that FSI wall stress mapping and RPI can be used as a tool for predicting the potential rupture of an AAA by predicting the actual rupture location, complementing current clinical practice by offering a predictive diagnostic tool for deciding whether to intervene surgically or spare the patient from an unnecessary risky operation.
    Annals of Biomedical Engineering 12/2014; · 3.23 Impact Factor
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    ABSTRACT: Purpose To investigate the variability in head computed tomographic (CT) scanning in patients with hemorrhagic stroke in U.S. hospitals, its association with mortality, and the number of different physicians consulted. Materials and Methods The study was approved by the Committee for the Protection of Human Subjects at Dartmouth College. A retrospective analysis of the Medicare fee-for-service claims data was performed for elderly patients admitted for hemorrhagic stroke in 2008-2009, with 1-year follow-up through 2010. Risk-adjusted primary outcome measures were mean number of head CT scans performed and high-intensity use of head CT (six or more head CT scans performed in the year after admission). We examined the association of high-intensity use of head CT with the number of different physicians consulted and mortality. Results A total of 53 272 patients (mean age, 79.6 years; 31 377 women [58.9%]) with hemorrhagic stroke were identified in the study period. The mean number of head CT scans conducted in the year after admission for stroke was 3.4; 8737 patients (16.4%) underwent six or more scans. Among the hospitals with the highest case volume (more than 50 patients with hemorrhagic stroke), risk-adjusted rates ranged from 8.0% to 48.1%. The correlation coefficient between number of physicians consulted and rates of high-intensity use of head CT was 0.522 (P < .01) for all hospitals and 0.50 (P < .01) for the highest-volume hospitals. No improvement in 1-year mortality was found for patients undergoing six or more head CT scans (odds ratio, 0.84; 95% confidence interval: 0.69, 1.02). Conclusion High rates of head CT use for patients with hemorrhagic stroke are frequently observed, without an association with decreased mortality. A higher number of physicians consulted was associated with high-intensity use of head CT. © RSNA, 2014 Online supplemental material is available for this article.
    Radiology 10/2014; · 6.21 Impact Factor
  • K Bekelis, S Missios, N Labropoulos
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    ABSTRACT: There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care with the diffusion of the novel technology of cerebral aneurysm coiling.
    International angiology: a journal of the International Union of Angiology 10/2014; 33(5):446-54. · 1.01 Impact Factor
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    ABSTRACT: Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal and extracranial carotid arteries. We present 3 cases of renal infarction complicating renal artery FMD in 42-, 43-, and 46-year-old females and provide a comprehensive review of the literature on this topic. In our patients, oral anticoagulation therapy was used to treat all cases of infarction, and percutaneous angioplasty was used nonemergently in one case to treat refractory hypertension. All patients remained stable at 1-year follow-up. This is consistent with outcomes in previously published reports where conservative medical management was comparable to surgical and interventional therapies. Demographic differences may also exist in patients with renal infarction and FMD. A higher prevalence of males and a younger age at presentation have been found in these patients when compared to the general population with FMD.
    Vascular and Endovascular Surgery 09/2014; · 0.77 Impact Factor
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    ABSTRACT: Background Information on ovarian vein thrombosis (OVT) is limited to some retrospective studies. The purpose of this prospective study was to evaluate the natural history and treatment outcomes of OVT. Methods Patients with documented symptomatic OVT who were treated with anticoagulation and had at least 3 months of follow-up were included. Outcomes of interest were recanalization rates, pain resolution, pelvic congestion syndrome, recurrent deep venous thrombosis (DVT), and mortality. All patients underwent clinical examination and duplex ultrasound; computed tomography venography was selectively performed. Results There were 23 women with a mean age of 44 years (range, 23-68 years). Fifteen (65%) right, 5 (22%) left, and 3 (23%) bilateral OVTs were detected. The median follow-up was 27 months (range, 3 months-7 years). The most common presentation was abdominal pain in nine patients (39%), followed by flank pain in six (26%). Two patients (9%) presented with dyspnea due to pulmonary embolism. The most prevalent condition was the puerperium (n = 9; 39%). Complete recanalization occurred in 16 veins (61%), partial recanalization in four veins (15%), and occlusion in six veins (24%) while patients were receiving anticoagulation. Four patients (17%) had lower extremity DVT during follow-up after the interruption of anticoagulation. Three patients (13%) developed pelvic congestion syndrome. All four deaths (17%) were due to cancer-related complications. Conclusions Symptomatic OVT is rare. Patients fare well with anticoagulation; complete recanalization occurs in about two thirds of the patients. Recurrent DVT is found in lower extremity veins after the interruption of anticoagulation in 17% of patients; mortality was seen only in cancer patients.
    Journal of Vascular Surgery: Venous and Lymphatic Disorders. 08/2014; 2(1):109.
  • 07/2014; 384(9938):129–130.
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    ABSTRACT: CVD is the result of venous reflux, obstruction or a combination of both. So far, attempts to correlate venous hemodynamic measurements with symptoms and signs of chronic venous disease (CVD) have produced poor to moderate results, probably because of lack of methods to quantitate obstruction and combine measurements of reflux and obstruction. Our hypothesis is that the combination of quantitative measurements of (a) overall reflux (superficial and deep) and (b) overall outflow resistance i.e. including the collateral circulation would provide a hemodynamic index that should be related to the severity of the disease.
    International angiology: a journal of the International Union of Angiology 05/2014; · 1.01 Impact Factor
  • Kimon Bekelis, Symeon Missios, Nicos Labropoulos
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    ABSTRACT: Several initiatives have been put in place to minimize healthcare expenditures. In new and evolving fields such as endovascular aneurysm treatment, there are limited data to support such measures. The objective of the present study was to develop and validate a predictive model of hospitalization cost after cerebral aneurysm coiling (CACo).
    Journal of Neurointerventional Surgery 05/2014; · 2.50 Impact Factor
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    ABSTRACT: Evaluate the short and longterm outcomes of percutaneous transluminal angioplasty in patients with hypertension and renal artery fibromuscular dysplasia (FMD) and identify specific patient factors that may affect outcomes. 29 patients with uncontrolled hypertension and renal artery FMD diagnosed by duplex ultrasound and angiography were prospectively enrolled. All patients underwent percutaneous transluminal angioplasty (PTA) with the goal of cure or improvement of hypertension. Follow-up was at onemonth, 6 months, 12 months and then yearly with minimum follow-up of 2 years and maximum of 5 years. Technical success from the intervention was 100%. 21 patients were included in the final analysis. One month after PTA mean SBP (138.1 mm Hg), DBP (78.6 mm Hg), and number of medications (1.4) were significantly reduced. 14/121 (67%) showed improvement of blood pressure and 7/21 (33%) showed no improvement. These two groups (improved vs. not improved) differed significantly in mean age at intervention (40.6 vs.58.3 years), duration of hypertension (3.1 vs. 15.4 years), SBP (150.4 mm Hg vs. 162.1 mmHg), DBP (86.4 mm Hg vs. 95.7 mm Hg), number of anti-hypertensive medications (2.2 vs. 3.0), serum creatinine (0.82 vs. 1.45), and renal resistive index (0.59 vs. 0.74). Mean followup was 3.86 years. Improvements in blood pressure and anti-hypertensive medications remained significant at fiveyear follow-up. PTA is effective in reducing blood pressure in patients with renal artery FMD.Age at intervention, duration of hypertension, and renal function may be used to predict outcomes prior to intervention.
    International angiology: a journal of the International Union of Angiology 05/2014; · 1.01 Impact Factor
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    ABSTRACT: This study was performed to precisely define the underlying pathophysiology in patients with active venous ulcers. A PubMed search was conducted from 1991 to 2013 to select papers reporting the anatomic and physiologic etiology of ulceration in CEAP Class 6 patients. Studies which did not decipher between active and healed ulcers, did not use clear definitions, or did not give detailed accounts on the distribution/extent of venous pathology were excluded. Using the PRISMA guidelines, 12 studies were selected for further analysis. Primary insufficiency was reportedly the most common etiology of ulcers. Reflux most frequently occurred in the superficial system, either isolated or in conjunction with perforating and/or deep systems. Combined superficial and deep disease was observed in a median of 11.6% of limbs (range of 0-48%). Triple system disease was seen in a median of 31.6% of limbs (range of 22-52%). Isolated deep reflux was infrequently reported (2.1-28.4% of limbs). Previous deep venous thrombosis, reported in a median of 33% of patients, is likely underreported as it may resolve without detectable damage. There is a lack of data in the literature regarding the etiology of chronic active venous ulcers. Insufficiency of the superficial venous system from the micro- to the macro-vasculature has been frequently implicated in the development of venous ulceration. A prospective randomized controlled study is required for more conclusive results.
    Phlebology 03/2014; · 1.92 Impact Factor
  • K Bekelis, S Missios, C Eskey, N Labropoulos
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    ABSTRACT: Aims: Several groups have demonstrated the safety of ambulatory cerebral angiography, with no patients experiencing complications related to early discharge. Although this practice appears to be safe, the socioeconomic characteristics factoring in the selection of the patients have not been investigated. Methods: We performed a retrospective cohort study involving 45,226 patients undergoing outpatient and 159,046 undergoing inpatient cerebral angiography, who were registered in the State Ambulatory Surgery Databases (SASD) and State Inpatient Databases (SID) respectively for 4 US States (New York, California, Florida, North Carolina). Results: In a multivariate analysis of diagnostic cerebral angiography, Caucasian race (OR 1.36, 95% CI, 1.31, 1.42) and male gender (OR 1.36, 95% CI, 1.31, 1.41), were significantly associated with outpatient procedures. Higher Charlson Comorbidity Index (CCI) (OR 0.60, 95% CI, 0.54, 0.67), high income (OR 0.70, 95% CI, 0.67, 0.73), high volume hospitals (OR 0.69, 95% CI, 0.66, 0.73), and coverage by Medicare/Medicaid (OR 0.96, 95% CI, 0.92, 0.99) were associated with a decreased chance of outpatient procedures. Institutional charges were significantly less for outpatient cerebral angiography. The median charge for inpatient diagnostic cerebral angiography was $26,968 as compared to $16,151 in the outpatient setting (P < 0.0001, Student's t-test). Conclusion: Access to ambulatory diagnostic cerebral angiography appears to be more common for patients with private insurance and less comorbidities, in the setting of lower volume hospitals. Further investigation is needed in the direction of mapping these disparities in resource utilization.
    International angiology: a journal of the International Union of Angiology 02/2014; 33(1):58-64. · 1.01 Impact Factor
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    ABSTRACT: Currently, the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary artery disease (CAD) and the correlation between CAD severity and AAA prevalence are not clearly known. We conducted a prospective study to determine the prevalence of AAA in patients undergoing coronary angiography and to determine the risk factors and a coronary profile associated with AAA. Over an 18-month period, abdominal aortic ultrasound was performed on 1,000 patients undergoing coronary angiography for suspected or known CAD, or prior to valve surgery. Clinical characteristics and coronary profile were collected from the patients. The overall number of previously repaired, already diagnosed, and new cases of AAA in the study population was 42, yielding a prevalence of 4.2%. Among the patients with newly detected AAAs, only two had an AAA diameter of >54 mm and were therefore treated surgically. In men aged ≥65 years, the prevalence reached 8.6%, while in men with three-vessel CAD it was 14.4%. Multivariate analysis showed that age ≥65 years (p = .003), male gender (p = .003), family history of AAA (p = .01), current smoking (p = .002), and three-vessel CAD (p < .001) were significantly associated with a higher prevalence of AAA. The prevalence of AAA was high in men aged ≥65 years and in those with three-vessel CAD regardless of age. While our findings do not prove the cost-effectiveness of screening for AAA in these high risk patients, they do support the usefulness of a quick ultrasound examination of the abdominal aorta during routine transthoracic echocardiography in such patients.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 01/2014; · 2.92 Impact Factor
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    ABSTRACT: -The relationship between biomechanical properties and biological activities in aortic aneurysms was investigated with finite element simulations (FES) and (18)F-fluoro-deoxyglucose ((18)F-FDG) positron emission tomography (PET). -The study included 53 patients (45 males) with aortic aneurysms, 47 infrarenal (AAA) and 6 thoracic (TAA), who had at least one (18)F-FDG PET/computed tomography. Over a 30-month period, more clinical events occurred in patients with increased (18)F-FDG uptake on their last examination than in those without (5/18 (28%) vs. 2/35 (6%); P=0.03). Wall stress and stress/strength index computed by FES and (18)F-FDG uptake were evaluating a total of 68 examinations. 25 (38%) examinations demonstrated at least one aneurysm wall area of increased (18)F-FDG uptake. The mean number of these areas per examination was 1.6 (18/11) in TAAs vs. 0.25 (14/57) in AAAs, while the mean number of increased uptake areas co-localizing with highest wall stress and stress/strength index areas was 0.55 (6/11) and 0.02 (1/57), respectively. Quantitatively, (18)F-FDG PET uptake correlated positively with both wall stress and stress/strength index (P<0.05). (18)F-FDG uptake was particularly high in subjects with personal history of angina pectoris and familial aneurysm. -Increased (18)F-FDG PET uptake in aortic aneurysms is strongly related to aneurysm location, wall stress as derived by FES and patient's risk factors such as acquired and inherited susceptibilities.
    Circulation Cardiovascular Imaging 11/2013; · 5.80 Impact Factor
  • Journal of Vascular Surgery 10/2013; 58(4):1156. · 2.98 Impact Factor
  • K Bekelis, N Labropoulos, P Pappas, A Gasparis
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    ABSTRACT: Aim: Velocity criteria for diagnosis of carotid stenosis are subject to flow phenomenon such as contralateral stenosis or occlusion. Duplex tri-axial diameter and cross sectional area measurements are potentially more accurate because they are anatomic. Methods: As part of a prospective study on triplanar ultrasound carotid stenosis measurements, 30 consecutive patients were studied by 3 independent operators to assess variability of the technique. PSV and EDV were recorded at the common and internal carotid arteries and Duplex B-mode long-axis and diameter views were obtained using color and/or power Doppler. Cross-sectional area (CSAS), minimal luminal diameter (MLD), and triaxial diameter measurements, based on the NASCET criteria were performed at the narrowest lumen. Results: The CSAS, MLD and triaxial diameter measurements were not significantly different in the 3 measurements and that was true for the 3 operators (ANOVA, P=0.1 for both). There were 4 patients where the velocity measurements differed by one stenosis grade, when compared to diameter. The triaxial diameter stenosis correlated well with the percent area reduction for all three measurements. Other than having a very good linear relationship (R2=0.95, R2=0.96, R2=0.93). The MLD was reduced with increasing grades of stenosis and provided a clear separation between the 50-69% and 80-99% grades with only a small overlap in the 70-79% grade. Conclusion: The present analysis demonstrates that CSAS and triaxial diameter can be performed by experienced investigators with low variability and good reproducibility. Velocity and planimetric measurements are complimentary in the assessment of carotid artery stenosis.
    International angiology: a journal of the International Union of Angiology 10/2013; 32(5):506-11. · 1.01 Impact Factor
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    ABSTRACT: Object Precise delineation of individualized risks of morbidity and mortality is crucial in decision making in cerebrovascular neurosurgery. The authors attempted to create a predictive model of complications in patients undergoing cerebral aneurysm clipping (CAC). Methods The authors performed a retrospective cohort study of patients who had undergone CAC in the period from 2005 to 2009 and were registered in the Nationwide Inpatient Sample (NIS) database. A model for outcome prediction based on preoperative individual patient characteristics was developed. Results Of the 7651 patients in the NIS who underwent CAC, 3682 (48.1%) had presented with unruptured aneurysms and 3969 (51.9%) with subarachnoid hemorrhage. The respective inpatient postoperative risks for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep vein thrombosis, pulmonary embolism, and acute renal failure were 0.7%, 15.3%, 5.3%, 1.5%, 1.3%, 0.6%, 2.0%, and 0.1% for those with unruptured aneurysms and 11.5%, 52.8%, 5.5%, 39.2%, 1.7%, 2.8%, 2.7%, and 0.8% for those with ruptured aneurysms. Multivariate analysis identified risk factors independently associated with the above outcomes. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated using the area under the receiver operating characteristic curve, and it was found to have good discrimination. Conclusions The featured model can provide individualized estimates of the risks of postoperative complications based on preoperative conditions and can potentially be used as an adjunct in decision making in cerebrovascular neurosurgery.
    Journal of Neurosurgery 09/2013; · 3.15 Impact Factor
  • Kimon Bekelis, Symeon Missios, Nicos Labropoulos
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    ABSTRACT: The Institute of Medicine called attention to the pervasive differences in treatments and outcomes between ethnic groups. We sought to highlight the geographic and racial disparities in access to treatment for unruptured cerebral aneurysms. We performed a retrospective cohort study involving patients with unruptured cerebral aneurysms from 2000 to 2010, registered in the National Inpatient Sample (NIS) database. Primary outcomes were those patients receiving treatment and the ratio of untreated to treated aneurysms per state. The purpose of this study was to determine if there were geographic and racial disparities in access to treatment of unruptured cerebral aneurysms based on the NIS. Logistic regression and analysis of variance (ANOVA) techniques were used. There were 57 418 patients diagnosed with unruptured aneurysms (mean age 61.4 years, 70.5% females), with 18 231 undergoing treatment. Males (OR 0.67, 95% CI 0.64 to 0.71, p<0.0001), Asian (OR 0.88, 95% CI 0.81 to 0.96, p=0.003), Hispanic (OR 0.76, 95% CI 0.65 to 0.90, p=0.001), African American (OR 0.57, 95% CI 0.53 to 0.62, p<0.0001), and patients without insurance (OR 0.76, 95% CI 0.67 to 0.87, p<0.0001) were associated with decreased chance of treatment. The opposite was true for lower Charlson Comorbidity Index (OR 3.03, 95% CI 2.71 to 3.39, p<0.0001), coverage by Medicaid (OR 1.12, 95% CI 1.03 to 1.23, p=0.012), or private insurance (OR 1.92, 95% CI 1.80 to 2.04, p<0.0001), and lower income (OR 1.22, 95% CI 1.15 to 1.31, p<0.0001). Significant regional variability was observed among the different states (p=0.006, ANOVA), with Maryland being an outlier. Based on the NIS database, the rate of treatment of unruptured cerebral aneurysms varies according to sex, race, and region.
    Journal of Neurointerventional Surgery 08/2013; · 2.50 Impact Factor
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    ABSTRACT: A right-sided aorta is a rare malformation which may be associated with other various types of congenital heart disease. We utilised haemodynamic, echocardiographic measurements, computerised tomography and image reconstruction software packages that were integrated in a computational fluid dynamics model to determine blood flow patterns in patient-based aortas. In the left-sided aorta, a systolic clockwise rotational component was present, while helical flow was depicted in the aortic arch that was converted in the descending aorta as counter-rotating vortices with accompanying retrograde flow. The right-sided configuration has not altered the orientation of the three-dimensional vortex, but intensification of polymorphic flow patterns, alterations in wall shear stress distribution and development of a lateral pressure gradient at the area of an aneurysmal anomaly was observed. Moreover, increments of Reynolds, Womersley and Dean numbers were evident. These phenomena along with the formation of the aneurysm might influence cardiovascular risk in patients with right-sided aortas.
    Computer Methods in Biomechanics and Biomedical Engineering 08/2013; · 1.79 Impact Factor

Publication Stats

3k Citations
481.73 Total Impact Points

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  • 2008–2014
    • Stony Brook University Hospital
      Stony Brook, New York, United States
  • 2013
    • Maastricht University
      • Algemene Heelkunde
      Maastricht, Provincie Limburg, Netherlands
    • University of Ioannina
      • Department of Mathematics
      Ioánnina, Ipeiros, Greece
  • 2011–2013
    • Dartmouth–Hitchcock Medical Center
      • Department of Surgery
      Lebanon, New Hampshire, United States
    • University of Thessaly
      • Department of Vascular Surgery
      Iolcus, Thessaly, Greece
  • 2009–2013
    • Stony Brook University
      • Division of Vascular Surgery
      Stony Brook, NY, United States
  • 2006–2008
    • Rutgers New Jersey Medical School
      • Department of Surgery (RWJ Medical School)
      Newark, New Jersey, United States
    • SAS Clinique Du Grand Large
      Décines, Rhône-Alpes, France
  • 2007
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
  • 2006–2007
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 1997–2007
    • Loyola University Medical Center
      • Department of Surgery
      Maywood, IL, United States
  • 1995–1998
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
  • 1992–1997
    • St. Mary’s Hospital for Children
      New York City, New York, United States
  • 1996
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      • Division of Oral Surgery
      Chieta, Abruzzo, Italy