N Labropoulos

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

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Publications (223)446.83 Total impact

  • 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. · 1.46 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;
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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; · 1.46 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; · 1.46 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; · 2.07 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. · 1.46 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. · 1.46 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; · 1.39 Impact Factor
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    ABSTRACT: Benchmarking of complications is necessary in the context of the developing path to accountable care. We attempted to create a predictive model of negative outcomes in patients undergoing cerebral aneurysm coiling (CACo). We performed a retrospective cohort study involving patients who underwent CACo from 2005 to 2009 and who were registered in the Nationwide Inpatient Sample database. A model for outcome prediction based on individual patient characteristics was developed. Of the 10 607 patients undergoing CACo, 6056 presented with unruptured aneurysms (57.1%) and 4551 with subarachnoid hemorrhage (42.9%). The respective inpatient postoperative risks were 0.3%, 5.7%, 1.8%, 0.8%, 0.5%, 0.2%, 1.9%, and 0.1% for unruptured aneurysms, and 13.8%, 52.8%, 4.9%, 36.7%, 1%, 2.9%, 2.3%, and 0.8% for ruptured aneurysms for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep vein thrombosis, pulmonary embolism, and acute renal failure. 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 by the area under the receiver operating characteristic curve, and it was found to have good discrimination. The presented model can aid in the prediction of the incidence of postoperative complications, and can be used as an adjunct in tailoring the treatment of cerebral aneurysms.
    Journal of Neurointerventional Surgery 07/2013; · 2.50 Impact Factor
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    ABSTRACT: BACKGROUND: Perforation of the inferior vena cava by filters struts is a known complication. The goal of our review is to assess the impact of inferior vena cava perforation by filters based on an open, voluntary national database. METHODS: We reviewed 3311 adverse events of inferior vena cava filters reported in Manufacturer and User Facility Device Experience database from January 2000 to June 2011. Outcomes of interest were incidence of inferior vena cava perforation, type of filter, clinical presentation, and management of the perforation, including retrievability rates. RESULTS: Three hundred ninety-one (12%) cases of inferior vena cava perforation were reported. The annual distribution of inferior vena cava perforation was 35 cases (9%), varying from seven (2%) to 70 (18%). A three-fold increment in the number of adverse events related to inferior vena cava filters has been noted since 2004. Wall perforation as an incidental finding was the most common presentation (N = 268, 69%). Surrounding organ involvement was found in 117 cases (30%), with the aorta being the most common in 43 cases (37%), followed by small bowel in 36 (31%). Filters were retrieved in 97 patients (83%) regardless of wall perforation. Twenty-five (26%) cases required an open procedure to remove the filter. Neither major bleeding requiring further intervention nor mortality was reported. CONCLUSIONS: Inferior vena cava perforation by filters remains stable over the studied years despite increasing numbers of adverse events reported. The majority of filters involved in a perforation were retrievable. Filter retrieval, regardless of inferior vena cava wall perforation, is feasible and must be attempted whenever possible in order to avoid complications.
    Phlebology 05/2013; · 2.07 Impact Factor
  • Dimitrios Virvilis, George Koullias, Nicos Labropoulos
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    ABSTRACT: Many variations in the anatomy of the carotid artery are described in the literature. There are few case reports of hypoplasia or the retropharyngeal course of the internal carotid artery. We describe the unique case of a 72-year-old woman with bilateral complete retroesophageal common carotid arteries and concomitant hypoplasia of the right carotid system. Anatomical detection of such a variation is critical because the misidentification of a retroesophageal carotid artery carries the risk of potential injury during orotracheal intubation and oropharyngeal procedures.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 05/2013; 57(5):1395-7. · 3.52 Impact Factor
  • R D Malgor, N Labropoulos
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    ABSTRACT: The advent of duplex ultrasound (DU) has changed vascular practice over the years. Venous anatomy, valve function and obstruction can be evaluated in real time using DU. It is a low cost, portable, non-invasive, safe and operator-friendly device that can be used for diagnosis, treatment guidance and follow-up. This paper defines the patterns, location and characteristics of venous reflux and also provides insightful information on acute and chronic venous obstruction.
    Phlebology 03/2013; 28(suppl 1):158-161. · 1.46 Impact Factor
  • R D Malgor, N Labropoulos
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    ABSTRACT: Venous thromboembolism is one of the most common causes of morbidity and mortality in modern societies. The entirety of events involved in venous thrombus formation and resolution remains to be elucidated. Temporal relation between the initial cellular insult, thrombus formation and resolution is critical for instituting a prompt treatment. This paper analyses the current basic knowledge and the events involved in venous re-modelling after an episode of venous thrombosis.
    Phlebology 03/2013; 28(suppl 1):25-28. · 1.46 Impact Factor
  • Phlebology 03/2013; 28 Suppl 1:1. · 2.07 Impact Factor
  • R D Malgor, N Labropoulos
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    ABSTRACT: Venous reflux often originates from saphenous trunks and their tributaries. In about 10% of the patients reflux derived from non-saphenous veins (NSV) such as those located in the buttock, postero-lateral thigh, vulva, lower posterior thigh, popliteal fossa, knee or along the peripheral nerves such as the tibial and sciatic nerve. It is also important to note that patients who had saphenous vein stripping or ablation have higher odds of presenting with NSV reflux. The majority of patients with NSV reflux have varicose veins and lower extremity oedema; however, about 10% of those patients present with skin damage. This paper analyses the patterns and types of NSV reflux for diagnosis and treatment purposes.
    Phlebology 03/2013; 28(suppl 1):51-54. · 1.46 Impact Factor

Publication Stats

3k Citations
446.83 Total Impact Points

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Institutions

  • 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