Michel Bosiers

MD
  • Function: Specialist
  • Speciality: Vascular Surgery
  • Country: DE
  • Working place: St. Franziskus-Hospital, Münster, DE

Activities

Case report

Percutaneous thrombectomy of multilevel iliofemoral DVT in 20y old female: a case report

In this case report a young female patient with DVT and severe symptoms was successfully treated with endovascular thrombectomy, using the Indigo CAT8 XTORQ catheter from Penumbra. You will see the case and learn some tips and tricks on handling the device.

Michel Bosiers
September 13, 2019 No Comments
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Review of the literature

When to use a self-expandable covered stent in the SFA in PAD patients?

In this presentation, we demonstrate three interesting and debatable PAD cases, where a self-expandable covered stent was used to treat different types of SFA disease. The decision making about the use of a self-expandable stent is supported by a current overview of the literature.

Michel Bosiers
December 18, 2018 1 Comment
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Comment on Oct 05, 2018

Raphael Coscas replied to your comment on presentation Clampless Anastomosis on the Supraceliac Aorta for Aorto-mesenteric Bypass.

»Thank you for your comment, This is not our standard technique since it leave a stent across the anastomosis and some uncertainties remain about the durability. However, we performed our first case 3 years ago (on the infrarenal aorta) and the patient is still doing well with a patent stent and bypass.«
Comment on Oct 02, 2018

Theodosios Bisdas commented on presentation Clampless Anastomosis on the Supraceliac Aorta for Aorto-mesenteric Bypass.

»Great contribution Raphael. Did I understand your technique right? Are you puncturing the graft twice or only at the distal part? How are you puncturing the aortic wall in order to introduce your wire? My second question: can you provide us the diameters of the graft and the BeGraft? Do you perform any predilatation of the aorta at the level of the anastomosis?«
Comment on Sep 04, 2018

Nicola Troisi replied to your comment on presentation TASC II D AORTO-ILIAC RECANALIZATION AND RECONSTRUCTION WITH SELF-EXPANDABLE STENTS.

»Thank you Michel for your comments. Step by step... As regards as the right side the first approach was retrograde femoral but I was not able to recanalize the iliac axis. So, I decided to perform a crossover approach. In my mind, the third option should be the brachial approach with a long sheath. Then, the choice to stent left EIA was based on the preoperative CT-scan showing circumferential calcifications with critical stenosis in the distal part immediately above the circumflex arteries. Finally, about your answers I am agree with you even if in my center we have a large experience of iliac kissing stenting with self-expandable stents with good outcomes during a long-term follow-up. I use covered stents just in cases where large thrombus is present.«
Comment on Sep 03, 2018

Michel Bosiers commented on presentation TASC II D AORTO-ILIAC RECANALIZATION AND RECONSTRUCTION WITH SELF-EXPANDABLE STENTS.

»Great case, Thanks for sharing! I have a few questions: - would you consider a transbrachial approach instead of cross-over: sometimes you don´t have enough pushability coming from cross-over. - was it necessary to stent the left EIA ? To answer your questions: - i prefer to use balloon expandable stents for the CIA, for the EIA i totally agree to use a self expandable. - if there is a large thrombus burden, i prefer to use covered stents, in this case with the strong calcification i think a non-covered stent should do the trick«
Case report

Treatment of a large thoracoabdominal aneurysm with narrow access vessels

This case report describes the treatment of a thoracoabdominal aneurysm with narrow access vessels and an upward facing right renal artery. The use of a flexible self expanding covered stent facilitates the attachment of the target vessel with your branch. To reduce the risk of paraplegia, a staged procedure was performed.

Michel Bosiers
August 12, 2018 1 Comment
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Comment on Aug 08, 2018

Michel Bosiers commented on presentation Treatment of a juxtarenal aneurysm with heavily calcified iliac arteries using a fenestrated endograft.

»Thanks Kostas, to give you a simple answer: because FEVAR was feasible. This patient would have required at least a double chimney, because the renal artery orifices are on the same level. As you can see on the image of the SMA, there is also some plaque/thrombus burden on the aortic wall, so an adequate treatment would not be possible without using a triple chimney. From the data published we know that the outcome of triple chimneys is not so good.«
Comment on Jul 05, 2018

Konstantinos Donas replied to your comment on presentation Gutters after Chimney EVAR: How „PERICLES and PROTAGORAS“ can protect ACHILLES heel?.

»Thank you Michel for your comment. The current body of evidence suggests indeed the use of chimney grafts in juxtarenal pathologies with involvement of one or max. 2 target vessels. Triple chimneys can have several risks and not only more type IA endoleaks. As we published together, use of bilateral access is associated with significant risk of cardiac and cerebrovascular events for those patients. Additionally, we have a risk of persistent type IA endoleak due to the risk of inadequate oversizing to wrap up around the chimney grafts. This possibility was obvious in the new Classification of gutter-related endoleaks based on the causative mechanisms, published last year in J. Endovascular Therapy. In summary, triple chimneys should be considered only in case of anatomical or clinical contraindications for f-EVAR. I hope that soon we will be able to evaluate this cohort of patients from the PERICLES group and provide more scientific impetus for this indication.«
Comment on Jun 15, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Hi Michel! Thank you for your question. Regarding your first question. I did not use for example the Endurant limb because of the length (82mm) and the difference of the materials compared to the cTAG (Dacron vs PTFE). I think the gutter could be an issue. The IIA-branch of the IBD device is tapered (16 to 12mm) and shorter (70mm). Regarding your second question, the downwards orientated branch for the LSA allows access for a branched endograft and principally for a transbrachial approach.«
Comment on Jun 15, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you, Martin! Well, we are far away from a well-established protocol for CSI protection. Especially, in that case, you have to be very quick after deploying the thoracic endograft over the aortic arch. There are some new filters for the brachiocephalic trunk and the LCCA but these are applicable only in TEVAR cases. When you have to get access for the supraaortic vessels you have no option to protect the brain. My measures are: 1. Remove very carefully the air from the devices 2. Check multiple times your angiographic catheters to avoid air embolisation 3. Avoid a lot of manipulations with your thoracic endograft 4. Introduce the large-bore sheaths (12F), when you really need them and not from the beginning of the procedure 5. Check the quality of your arch at the angio-CT before planning your procedure.«
Comment on Jun 15, 2018

MARTIN MARESCH commented on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Amazing case Theo! Great tutorial from many points of view. Great discussion. Meticulous planning is the key to success in these cases! That's why they didn't use C-S bypass, Michael even so it would make sense, but this would have closed the door for further interventions distally if needed. Theo, can you comment on your CSI protective measures in complex TEVAR cases and what's the incidence of stroke and how to minimize it? Thanks«
Comment on Jun 11, 2018

Özgün Sensebat replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you for your answer Theo! My question was not precise, sorry. It is obvious, that you've done a great case with this chimney/periscope exclusion and not with a CMD. I am sure the planning was complex. My question is your general opinion about CM-branched-devices for the arch if indicated. You answered my question why it was not possible in this particular case. Maybe it is possible in the future to see a CMD-case for the arch at Vascupedia. Your opinion about the indication and characteristics would be valuable for the vascular public. Again, great job!«
Comment on Jun 11, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you Arne for your questions. 1. We decided against a 3 chimney for 2 reasons: (a) to avoid a bigger gutter and (b) to have the option for an antegrade (transbrachial) access to the descending aorta (e.g. further endovascular repair with fenestrated or branched endograft) 2. See my comment to Dr. Sensebat 3. The patient will receive dual antiplatelet treatment for 3 months and afterwards only ASA. However, I cannot support this with any kind of evidence. The advantage is that we have large bridging stent-grafts (12 mm for the brachiocephalic trunk and 10mm for LCCA and LSA).«
Comment on Jun 11, 2018

Theodosios Bisdas replied to your comment on presentation Total endovascular treatment of the aortic arch after type A dissection with chimney and sandwich technique.

»Thank you Özgün for your question. This was not a custom-made device, but an off-the-shelf treatment with chimney and sandwich technique. A custom-made device was not indicated in that case due to the short length of the replaced ascending aorta. There are strict inclusion and exclusion criteria for those cases. We decided to go forward with an endovascular approach due to the comorbidity of the patient and the redo operation.«
Comment on Jun 07, 2018

Özgün Sensebat replied to your comment on presentation Transcubital Onyx Embolization of a Type 2 Endoleak after EVAR.

»Maybe I expressed myself not clearly. An Endoleak Type 1 or 3 is of course detectable by a duplex-scan very well. What I meant is something different. I am talking about an upcoming problem (I think I wrote that word in my former reply). Degenerations of the necks or a beginning stent migration weren’t the endpoints of this study. Just the detection of the endoleak was examined. This is not what I am talking about. For me, a CT scan is still the only tool we have, which can detect anatomically or graft-related problems before a Type 1 or 3 Endoleak is existing. You can’t get this information from a duplex scan. I hope, you understand now my comment. Thank you for mentioning the studies above, but they are really well known. Even for me. Warm regards«
Comment on Jun 07, 2018

Özgün Sensebat replied to your comment on presentation Transcubital Onyx Embolization of a Type 2 Endoleak after EVAR.

»Maybe I expressed myself not clearly. An Endoleak Type 1 or 3 is of course detectable by a duplex-scan very well. What I meant is something different. I am talking about an upcoming problem (I think I wrote that word in my former reply). Degenerations of the necks or a beginning stent migration weren't the endpoints of this study. Just the detection of the endoleak was examined. This is not what I am talking about. For me, a CT scan is still the only tool we have, which can detect anatomically or graft-related problems before a Type 1 or 3 Endoleak is existing. You can't get this information from a duplex scan. I hope, you understand now my comment. Thank you for mentioning the studies above, but they are really well known. Even for me. Warm regards«
Comment on Jun 07, 2018

Konstantinos Stavroulakis commented on presentation Transcubital Onyx Embolization of a Type 2 Endoleak after EVAR.

»Özgün allow me to disagree. In a metaanalysis published in BJS (Br J Surg. 2012 Nov;99(11):1514-23.) duplex ultrasound was found to be specific for detection of types 1 and 3 endoleaks. Moreover, in a single center experience published from Antonello et al (J Vasc Surg. 2013 Oct;58(4):886-93.) EVAR was associated with a higher decline in renal function compared to open repair. The post-operative survaillance with CT scan might be the main reason for this finding.«
Comment on Jun 06, 2018

Özgün Sensebat commented on presentation Transcubital Onyx Embolization of a Type 2 Endoleak after EVAR.

»Of course, the aneurysm diameter is the most important factor for a treatment indication. But a regularly CT-Scan detects an upcoming Type-1-EL due to a neck degeneration or stent-migration. I think the duplex scan is not a proper tool to detect those problems. So for me, an EVAR-patient normally needs a continuous follow up including a CT-scan. The exception might be the patient with a complete decreasing of its aneurysm diameter down to the graft diameter or the patient with long aneurysm-necks, which are able to be examined accurately by a KM enhanced duplex-ultrasound«
Comment on Jun 06, 2018

Özgün Sensebat commented on presentation Transcubital Onyx Embolization of a Type 2 Endoleak after EVAR.

»Thank you for your kind words. Here are my answers to your questions. 1) Usually, I use for the treatment of Type2-EL Onyx. In case of bigger vessels eventually coils as an add-on. In case of a Type1-EL for example due to a gutter-EL after CHEVAR or periscope-technique, we have good experiences with coils (Penumbra or Concerto). We prefer to treat classic Type 1 EL with an extension, a type 1a eventually with the support of an endoanchor (Heli-FX), a type 1b with an iliac-side-branch if possible. 2) Generally, we try to embolize as little as possible and to treat exactly the feeding branch. Especially the treatment of the IMA has to be done precious. We are afraid of embolizing bigger or accompanying vessels like the superior rectal artery or the complete internal iliac. Even in the lumbar territory you never know the exact effects of the embolization. Till now we luckily never had a spinal ischemia, so we are a bit more generous. If we can't reach the main feeding vessel branch, we accept a distance embolization of lumbar arteries with Onyx. 3) Our postop protocol requires a Duplex-scan after three months and a CT-scan after six months if the embolization was successful. Our main objective is the aneurysm diameter. If this is stable or decreasing, we plan the next CT-scan every 12 months, if not again after six months. If the artifacts are enormous, we check ta possible endoleak with an invasive angiogram. I hope I could answer your questions. Feel free to contact me any time. Thank you for your interest.«
Comment on Jun 06, 2018

Efstratios Georgakarakos commented on presentation Transcubital Onyx Embolization of a Type 2 Endoleak after EVAR.

»Excellent demostration of the devices and materials, step-by-step, really illuminating for me, thank you very much Özgun. Just three short questions: 1) what is your preference criteria for Onyx over other embolizing agents, such as coils or NBCA, coils or other agents? 2) apart from the feeding vessel (i.e. IMA), do you usually take care of any outflow vessels (eg lumbar arteries)? 3) What is your standard visualization protocol of follow-up after embolozation? I usually have difficulties to detect any angiographic leak reccurence with CTAngiography postoperatively due to artifacts caused by the embolic agent...«
Clinical investigation

The CLEAR-ROAD study: Overview of the results

This study investigates the 30-day and 12-month outcomes of the Roadsaver carotid stent (Terumo) for the treatment of carotid artery stenosis in symptomatic and asymptomatic patients. Check the rationale of the study, the inclusion and exclusion criteria, the characteristics of the device and the take-home messages of the study.

Michel Bosiers
May 27, 2018 No Comments
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Poll 04/10/2019 – 31/10/2019

Choice of antiplatelet therapy around complex revascularisation

A 79-year-old diabetic male patient with no history of coronary disease is referred to you to undergo angioplasty for tissue loss on the tips of the hallux and second toe. He is taking Aspirin 75mg. From preoperative imaging he needs a 20cm SFA occlusion stopping before the adductor hiatus recanalizing as well as multilevel tibial disease which appears to be a combination of short occlusions and stenoses. The dorsal pedal is seen in the foot and is in continuity with the arch. The PT artery appears occluded through it’s whole length.

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Poll 05/09/2019 – 30/09/2019

Online education in vascular medicine

Shape your learning experience on Vascupedia

 

Dear colleagues, our mission is to help physicians worldwide to bring their interventions to perfection. Our hope is to indirectly contribute to safety and well-being of patients with vascular diseases.

Over a year ago, we started Vascupedia as a unique online project that we believe fulfills the need for free education in the challenging field of Vascular Medicine. Now it’s time to ask you to help us to become better for you! Are we offering the right information in the right way at the right level? Is there anything missing to support you in your quest to grow your knowledge to treat your patients in the best possible way? Please complete this short survey to make sure we will work on improving the platform to serve YOUR educational needs!

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Poll 01/08/2019 – 31/08/2019

The Type II Endoleak

Patient’s characteristics

 

Gender: Male

Age: 68 years old

Comorbidity: Arterial hypertension, active smoker

Underwent EVAR 2 years ago

Symptoms:  None

DUS/CT A: Aneurysm sac growth > 7mm compared to last CT scan with evidence of type II Endoleak (Inferior mesenteric artery)

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Poll 01/05/2019 – 31/05/2019

The radiation exposure

Since January 2018, employers in the U.K and Europe have had to comply with their duties under the Ionising Radiations Regulations 2017, IRR17. Previous to this most health trusts working with ionising radiation followed IRR99.

The main changes since the last edition (IRR99) that affect the operator:

  • The dose limit for exposure to the lens of the eye has been reduced from 150 mSv to 20 mSv in a year. This is usually assessed using forehead monitoring bands.

It is the duty of the operator to control methods for restricting exposure to ionising radiation by use of distance and shielding etc.

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Poll 06/01/2020 – 31/01/2020

VASCUPEDIA@LINC – ENDOLEAKS-CASE-BASED SOLUTIONS

The topic of this month is called ENDOLEAKS-CASE-BASED SOLUTIONS and aims to provide more information to the discussants of the session about endoleaks that will take place on Thursday, January 30, 2020 in Leipzig, during the LINC symposium. Take the opportunity to answer the questions and to inform the experts about your current practice for the treatment of all type of endoleaks.

Your participation will provide unique data for an interesting discussion and your answers will challenge the experts during the session.

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Poll 02/02/2019 – 28/02/2019

The acute limb ischemia

Patient’s characteristics

Gender: Female

Age: 65 years old

Comorbidity: Arterial hypertension, Dyslipidemia

Symptoms:  Acute onset of claudication (<2 weeks), Rutherford class 3 of the left limb

Previous operations: None

ABI: 0.5

DUS: Occlusion of the left popliteal artery

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Poll 01/12/2018 – 31/12/2018

Chronic deep vein thrombosis and postthrombotic syndrome

Case presentation:

41 years old female patient presenting with swelling of both limbs, diffuse aching, heaviness and tiring of both extremities since 5 years from a previous deep vein thrombosis on both limbs. At the time of presentation, the patient showed severe dermatoliposclerosis on the right extremity and ulceration at the level of the left internal malleolus. The patient had no other risk factors except Factor V Leiden mutation.

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Poll 01/11/2018 – 30/11/2018

Ilio-femoral deep vein thrombosis

45 years old female patient presenting with painful swelling of the right limb during the last 24 hours. Wells score on admission was 4 points. The duplex ultrasound scanning revealed a femoropopliteal and iliac deep vein thrombosis. No other risk factors were present. No previous operations. No thrombophilia documented.

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Poll 01/10/2018 – 31/10/2018

Critical limb-threatening ischemia – CLI Global Society

Patient’s characteristics

 

Gender: Male

Age: 79 years old

Comorbidity: Arterial hypertension, hypercholesterinemia, chronic kidney disease (GFR: 53 ml/min/1,73m²), NYHA II, Coronary artery disease, previous CABG

Symptoms:  Toe ulceration of the left limb

Previous operations: None

ABI: incompressible, Toe pressure: 32 mmHg

Vascular Imaging – Duplex ultrasound: Isolated tibial vessel disease

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Poll 01/08/2018 – 31/08/2018

Asymptomatic carotid artery disease

Patient’s characteristics

 

Gender: Female

Age: 72 years old

Comorbidity: Arterial hypertension, hypercholesterinemia, previous smoker

Symptoms: None

Previous operations: None

Vascular Imaging of the left internal carotid artery: Duplex ultrasound with peak systolic velocity (PSV)> 230 cm/sec

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Poll 13/04/2018 – 30/06/2018

Topic: Asymptomatic juxta- and pararenal aortic aneurysms

Patient’s characteristics

Gender: Female
Age: 75 years old
Comorbidity: Arterial hypertension, hypercholesterinemia, previous aortocoronary bypass grafting, previous myocardial infarction, previous smoker, peripheral arterial disease, atrial fibrillation
Symptoms: None
Previous operations: None

 

Aneurysm characteristics:

Max. aneurysm diameter: 54 mm

Length of proximal infrarenal neck: 0 mm

Distance between SMA and LRA: 20 mm

Diameter of renal arteries: RRA: 5,3 mm, LRA: 6 mm

Suprarenal angulation: 60°

Diameter of distal neck: 30 mm

Minimum diameter of common iliac arteries: R: 11 mm, L:9 mm

Maximum diameter of common iliac arteries: R: 11 mm, L: 14 mm

Minimum diameter of external iliac arteries: R: 7 mm, L: 6,2 mm

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