Konstantinos Stavroulakis

MD
  • Function: Consultant
  • Speciality: Vascular Surgery
  • Country: GER
  • Working place: St. Franziskus Hospital, Münster, GER

Activities

Recorded video case

IVUS guided kissing endovascular lithoplasty and bare-metal-stent implantation for a coral reef aortic stenosis in visceral segment

Recorded case of a 72 yrs old woman with CLTI (Rutherford V,  TASC D lesion), not suitable for open repair, treated in a hybrid setting with IVUS guided kissing endovascular lithoplasty and bare-metal-stent implantation for a coral reef aortic stenosis in visceral segment, with a stent-graft for the right CIA and bare-metal-stent for the right CEA for the iliac high-grade stenosis and a femorofemoral bypass.

Konstantinos Stavroulakis
May 14, 2020 No Comments
Show presentation
Comment on Apr 24, 2020

Vivek Agarwal commented on presentation Aspirational Mechanical Thrombectomy in AVF.

»Hi.Thanks for the nice presentation I had a patient with long segment thrombosis of cephalic vein, approx 3 cm distal to brachio cephalic fistula. There was an acute thrombus with aneurysmal dilation of the cephalic vein proximally with decreased calibre of the vein and internal thrombus extending to the cephalic _ subclavian junction. What would he your approach in such patients. Thanks«
Comment on Jun 27, 2019

Özgün Sensebat replied to your comment on presentation Endovascular treatment of subclavian artery occlusive disease.

»Thank you for your questions. I prefer an endovascular treatment of subclavian lesions. Therefore, the level of evidence is very poor to choose the right device (POBA, DCB or BMS). Generally the SCA lesions are heavily calcified lesions. Compared to the common iliacs I prefer a balloon expandable stent. I don't have any experience with laser atherectomy. It would be great to see a case report or some visual results you have. You can upload it here on Vascupedia! Kind regards«
Comment on Jun 27, 2019

Özgün Sensebat commented on presentation Endovascular treatment of subclavian artery occlusive disease.

»Thank you for your questions. I recommend endovascular therapy for subclavian artery diseases. Generally, you have to treat calcified lesions in this area. Like in the common iliacs I prefer a balloon expandable Stent. There is still no evidence for POBA, DCB or BMS for the treatment of SCA. Your second question is very interesting. I have no experience with a laser atherectomy device. I have to learn more about it. Is it possible to share your experience with us? Maybe a small case report here on Vascupedia? Kind regards.«
Comment on Jun 17, 2019

commented on presentation Endovascular treatment of subclavian artery occlusive disease.

»Great presentation and Fantastic use of Endovascular IR Techniques. . My Questions are about : 1.Why Not Use Paclitaxel drug coated balloons in the treatment of Subclavian Arterial Atherosclerotic stenosis? 2. Instead of Snaring CTO Wires to gain access through heavily Calcified lesion; use "DABRA Laser Atherectomy" device and then do balloon dilation, deploy balloon expandable high radial force BMS. .«
Clinical investigation

The value of peripheral arterial IVUS in decision making

Despite the continuous development of endovascular modalities we still base our therapy in conventional angiographic imaging. IVUS might help us, however, to better understand the characteristics of the disease and guide our treatment. This presentation summarizes the value of peripheral arterial IVUS in our decision making process.

Konstantinos Stavroulakis
April 17, 2019 1 Comment
Show presentation
Comment on Jan 30, 2019

Fernando Gallardo commented on presentation Calcium: The Achilles Heel of Endovascular Procedures?.

»Thanks for sharing this excellent presentation Dr Stavroulakis. Calcium is a challenge. I agree with your algorithm showed at the lasts slides, for long CTO, in old patients, about the recommendation of the need of stents. In my humble opinion, and even if I am also a believer of the "don't live nothing behind concepts", my personal experience is that in this more 15 length CTO, many times recanalized subintimal I don't achieve a great vessel preparation , and recoil is there after DEB, also many non limítanos flow dissection, so my option is to leave a BMS, or covered stent, or DES there if not used DEB. I also agree that for young patients, claudicants, atherectomy devices + vessel preparation and DEB should be the first strategy and yes, avoid stent in patients with large expectancy of live. Best regards.«
Review of the literature

Calcium: The Achilles Heel of Endovascular Procedures?

How does calcium influence your treatment strategy? A short presentation regarding the impact of calcium in the treatment of femoropopliteal disease and a proposed algorithm for the use of scaffolds or ‘leave-nothing-behind’ strategies for severely calcified lesions.

Konstantinos Stavroulakis
January 28, 2019 2 Comments
Show presentation
Case report

Periscope and Chimney-EVAR for a ruptured AAA following infrarenal EVAR

Despite the latest advances in both endovascular field and open repair, a ruptured AAA still remains one of the most challenging situations in vascular medicine. This case shows the use of chimney and periscope grafts for the treatment of a Type Ia Endoleak in patient presenting with a ruptured AAA.

Konstantinos Stavroulakis
September 19, 2018 No Comments
Show presentation
Comment on Aug 13, 2018

Theodosios Bisdas replied to your comment on presentation Paving and cracking technique for severely calcified SFA lesions.

»Dear Fernando, Regarding your questions: 1. Exactly, we performed an endo-bypass with Viabahn and we reinforced the stent-graft at the level of the severe calcification. 2. I have also the same opinion, but this was challenged by other specialists. We have no data regarding this issue in the bypass studies because the quality of the vessel wall was not always analyzed. 3. Totally agree. 4. When you decide to perform an endobypass I do not think that you need such a dedicated device for vessel prep and cause extra costs, because you are going to use a non-compliant balloon for the paving and cracking technique. If you decide to leave nothing or a BMS behind, I would suggest cutting balloon or Shockwave balloon.«
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 Aug 02, 2018

Fernando Gallardo commented on presentation Paving and cracking technique for severely calcified SFA lesions.

»Thanks for sharing this complex case Theo. Just two comments, 1. How many stents did you finally use in this case? Once you have crossed the lesion why not perform a endobypass with 25 cm Viabahn? or did you use this ballon expandable stent to reinforce the Viabahn?? 2. Even with such calcifications, I don't agree that PTFE fempop bypass has superior patency to endobypass with Viabahn. 3. I know you are most experienced than me, but I recommend you US guided puncture always, specially in this calcified arteries, all closure devices can fail if you puncture in a calcium plaque and the only way to avoid it is with US guidance. 4. Do you see role of SERRATO/CHOCOLATE/SCORED OR CUTTING BALLON for vessel preparation here?? Best regards, Fernando«
Comment on Jul 29, 2018

Konstantinos Stavroulakis commented on presentation Paving and cracking technique for severely calcified SFA lesions.

»Thank you Theo for this interesting case. 2 Questions as always: 1. If you have to deal with such a heavy calcification why not preparing the vessel with endovascular lithotripsy and proceed to either DCB angioplasty or Interwoven stent deployment? 2. Do you think that this patient would benefit from a primary above the knee bypass given 1) the severe calcification and the length of the CTO, which will surely challenge the outcomes of endovascular therapy, and 2) the superior outcomes of primary surgery than secondary grafting after endo failure in CLI patients?«
Comment on Jul 19, 2018

Marc Bosiers replied to your comment on presentation Overview DCB treatment in BTK arteries.

»Dear Konstantinos, In my opinion DCB in BTK arteries should be reserved within a clinical trial until further evidence of superiority is available.«
Comment on Jul 12, 2018

Konstantinos Stavroulakis replied to your comment on presentation Hybrid revascularization of an acute iliac vessel occlusion: Keep the hypogastric patent.

»Excellent suggestion! Regarding the etiology of the occlusion, the preoperative CT scan revealed a thrombosed atherosclerotic plaque of the common iliac arteries and the distal aorta. Thus we covered this lesions with 2 iCAST stent grafts. It is not a real aortic dilation but an artifact caused from the position of the diagnostic catheter.«
Comment on Jul 11, 2018

Dixon Santana commented on presentation Hybrid revascularization of an acute iliac vessel occlusion: Keep the hypogastric patent.

»Very interesting case and rationale. I agree that in the presence of one internal iliac artery you have to protect it and avoid inadvertent emboli intoit while attempting an ipsilateral fogarty embolectomy. Another approach to this same problem could had been to bring an 8mm non compliant balloon theought the ipsilaterla left common femoral artery in a retrograde approach and “oush” the clot up into the aorta. The balloon is left inflated then you go on to complete the open embolectomy through the right femoral approach. I see this patient has a small aortic dilatation which was not covered by your stents. Do you see this being the etiology of the acute thrombosis? Interesting case.«
Technical note

Hybrid revascularization of an acute iliac vessel occlusion: Keep the hypogastric patent

Bilateral hypogastric artery occlusion is associated with increased morbidity in patients with acute limb ischemia. Although transfemoral lilac thrombectomy is considered a straightforward procedure, it might lead to an occlusion of the hypogastric artery. However, simple endovascular techniques can be helpful in keeping the hypogastric arteries patent.

Konstantinos Stavroulakis
July 7, 2018 2 Comments
Show presentation
Comment on Jul 02, 2018

Martin Schroeder commented on presentation Hybrid atherectomy for the infrainguinal arteries: why, when and how?.

»Dear Theo Thank you for this excellent presentation. What possibilities do you have if you receive a recanalization subintimally, can you also use the hybrid atherectomy system or is it absolutely necessary to have a true lumen for the atherectomy? If yes - is there a good tip for this? Thanks in advance. Martin«
Comment on Jun 28, 2018

Konstantinos Stavroulakis commented on presentation Overview DCB treatment in BTK arteries.

»Dear Dr. Bosiers, excellent presentation in a very controversial topic. Do you think that, we should use DCBs in BTK lesions only in the framework of clinical trials? And if not, which kind of lesions would you treat with DCB angioplasty below the knee?«
Comment on Jun 18, 2018

Theodosios Bisdas replied to your comment on presentation Hybrid atherectomy for the infrainguinal arteries: why, when and how?.

»Thank you Kostas! Regarding your questions: 1. It depends on the vessel that you treat; for SFA I would use the recommended Nitrix wire (Medtronic) or the hi-torque Iron Man (Abbott) and for the below-the-knee arteries more stiff wires like the Hi-Torque Extra S'port (Abbott) and Astato XS 20 (Asahi) 2. I do not use a DPD and I would not recommend it, because you may have problems between the proximal tip of the device and the wire of the filter. 3/4. At the moment I use atherectomy for tibial disease only in case of in-stent stenosis and severe recoil after PTA. If I perform atherectomy, then I would combine it with DCB. Do you have a different algorithm?«
Comment on Jun 18, 2018

Konstantinos Stavroulakis replied to your comment on presentation Surgical thrombectomy and DCB angioplasty for AV fistula salvage.

»Dear Stratos, thank you for your comment. To be honest, I am not sure which is the best treatment strategy for these lesions. Based on our algorithm we try to avoid any permanent scaffolding. Nonetheless, in the absence of head to head comparisons it is not possible to make any evidence based recommendations.«
Comment on Jun 14, 2018

Efthymios Beropoulis commented on presentation Validation of the WIfI classification system in nondiabetic patients treated by endovascular means for critical limb ischemia.

»Dear Konstantinos, Thank you for the interesting question. According to the initial publication of WIfI from Mils at JVS (doi: 10.1016/j.jvs.2013.08.003) the estimated likelihood of benefit of revascularization for patients with a low WIfI score would be also very low. On the other hand, we do know that critical threatening limb ischemia (CTLI) is even today associated with high amputation- (approx. 20%) and morbidity rates (approx. 25%) within a year. Moreover, revascularization for limb salvage is indicated wherever feasible (recommendation IB, ESC Guidelines 2017, doi:10.1093/eurheartj/ehx095). In my opinion, WIfI score is undoubtedly a useful evaluation tool, but for the final decision regarding revascularization or not, patients' comorbidity index and anatomic disease pattern should be taken into consideration.«
Case report

Surgical thrombectomy and DCB angioplasty for AV fistula salvage

Drug coated balloon (DCB) angioplasty has been proven a valuable tool in the treatment of femoropopliteal PAD. But do we have enough data to support the use of DCBs in AV fistula salvage procedures? In this case DCB angioplasty was performed to treat a post-thrombectomy vein stenosis.

Konstantinos Stavroulakis
June 13, 2018 2 Comments
Show presentation
Comment on Jun 13, 2018

Konstantinos Stavroulakis replied to your comment on presentation Successful treatment of an occluded drug-eluting stent (DES).

»Surely, the RELINE trial (J Endovasc Ther. 2015 Feb;22(1):1-10.) is a very interesting study, which, however, included also a small number of patients (39 in the stent graft group) and reported patency rates of 54% at 24 months. Moreover, and similar to the findings of this retrospective single center study, the multi center SALAVAGE registry (Catheter Cardiovasc Interv. 2012 Nov 1;80(5):852-9) reported 12 months primary patency rates of 48% following laser atherectomy and stent graft implantation for ISR. This study included also a small number of patients. There is no doubt that a physical barrier might be useful in selected cases but there is no body of evidence to support the use of grafts as primary treatment option of ISR.«
Comment on Jun 13, 2018

Konstantinos Donas replied to your comment on presentation Successful treatment of an occluded drug-eluting stent (DES).

»Thank you Kostas for your comment. I had in my mind writing about superiority of covered stents in ISR, the multicenter randomized trial (RELINE trial), which was published in 2015 from Bosiers M, et al and showed significant better outcomes for the covered stents compared to PTA. I believe that this study has a much better impact and value than the retrospective single center study of ca. 25 patients, which you mentioned. There is no doubt, that we have more than one options to treat complex SFA lesions with pros and cons for each approach. In my case the possible presence of residual thrombus material after the use of Rotarex was the major argument to deploy a covered stent minimizing the risk of peripheral embolization. Further FU is off course mandatory in order to ensure patency and durability of this treatment option. Again, many thanks for your comment and keep in touch.«
Comment on Jun 13, 2018

Konstantinos Stavroulakis replied to your comment on presentation Successful treatment of an occluded drug-eluting stent (DES).

»Dear Kostas, just two comments. I am not so sure that the current literature supports the primary use of stent grafts for the treatment of ISR. A real world study evaluating the performance of stents grafts for denovo and ISRs in femoro- popliteal arterial obstructive disease concluded that stent grafts have high restenosis and failure rates, of both stent patency and limb outcomes (Catheter Cardiovasc Interv. 2018;91:1130–1135.). Quite the contrary, numerous studies support the use of DCBs +/- debulking (laser atherectomy, rotation atherectomy etc) and some registry data the use of DES. Regarding the gold standard of SFA treatment, I totally agree that the preservation of the collateral network is crucial. Nonetheless, this can be achieved with all available treatment options except stent grafts (and not only with BMS). Thus, a more individualized approach based on lesions (CTO, calcification, length etc) and patients characteristics (CKD, compliance) seems more reasonable.«
Comment on Jun 12, 2018

Konstantinos Donas commented on presentation Successful treatment of an occluded drug-eluting stent (DES).

»Thank you Efstratios for your comment! I am considering the use of covered stents as first-line treatment in case of thrombotic occlusion with suspicion of residual thrombus formation after succesful recanalisation, or in case of accidental perforation of the SFA during endovascular maneuvers. Finally, the current literature supports also the use of covered stents as first line treatment in case of in-stent stenosis in the SFA. However, my first choice for the SFA, in general, remains the use of a bare metal stent, because I believe that patent collateral pathway of the SFA is very crucial and should be always preserved.«
Comment on Jun 12, 2018

Hirofumi Ohtani replied to your comment on presentation Fully Percutaneous Transaxillary Transcatheter Aortic Valve Implantation in patients with a patent left internal mammary graft.

»Thank you for the questions. 1) selfexpandable stents as viaban or fluency are definitely preferable. At the moment of the interventions we did not have the correct size. Corrective action: Now we have them on the shelf!!! 2) to puncture under eco and fluoro+contrast guidance in the more distal portion of the axillary artery. Also, theoretically, the proglide pre-closure is little traumatic to the vessel.«
Comment on Jun 11, 2018

Konstantinos Stavroulakis commented on presentation Fully Percutaneous Transaxillary Transcatheter Aortic Valve Implantation in patients with a patent left internal mammary graft.

»Excellent presentation of a challenging case. I have only 2 questions: 1) Do you have any concerns regarding the deployment of a balloon expandable covered stent in an area exposed to high mechanical stress? 2) Median nerve injury can be a major complication of a percutaneous transaxillary access. Which is your strategy/approach in order to avoid it?«
Comment on Jun 11, 2018

Özgün Sensebat commented on presentation Fully Percutaneous Transaxillary Transcatheter Aortic Valve Implantation in patients with a patent left internal mammary graft.

»Thank you Hirofumi Ohtani for your tremendous presentation. I totally agree with the potential for a valuable arterial access. Your experience is also important for CMD-BEVAR or T-branch Devices. One question: would it be possible to use Prostar XL instead of ProGlide if the vessel diameter is big enough? Regards«
Comment on Jun 11, 2018

Bella Huasen replied to your comment on presentation Aspirational Mechanical Thrombectomy in AVF.

»Thank you Konstantinos! I think I probably should create some images and scenarios to explain this better. Bare with me and I will answer this properly :)«
Comment on Jun 07, 2018

Efstratios Georgakarakos replied to your comment on presentation A case of bilateral symptomatic aneurysms of common femoral arteries: surgical management.

»Hi Theo and thanks for your attention. I usually suggest a FU examination at 1-, 6- and 12months postoperatively. If a femoral aneurysm is asymptomatic most authors suggest intervention at a diameter greater than 2.5-3.0cm. Depending on the size of the inflow and outflow vessel to be clamped, i prefer Dacron for large diameters or PTFE if the vessel sizes are smaller. I certainly perform a CTA scan to rule out comcomitant aneurysms in remote locations, since femoral aneurysms -although rare, accounting for 3-4% of all peripheral aneurysms- are bilateral in 1/3 of cases while associated with aortic- or popliteal aneurysms in 66%. Therefore, a CTA is mandatory.«
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...«
Comment on Jun 05, 2018

Özgün Sensebat commented on presentation Endovascular treatment of subclavian artery occlusive disease.

»Thank you, Konstantinos! 1) when I first saw the CT scan I was sure, this lesion would be - because of the calcified occlusion- difficult to treat. So I wanted a proper imaging of the arch by a transfemoral access. My plan A was a retrograde, transbrachial recanalization but I was not successful. Despite my first suggestion, I was able to get a low profile wire from transfemoral through the occlusion (plan B), but it was not possible to follow a balloon or a catheter to change for a stiffer wire. So I decided to create a pull through wire (plan C) by snaring over the already created trsnsbrachial access. 2) no I usually prefer covered BE Stents for subclavian diseases. But in this case, the calcification was very severe. I wanted the highest available radial force. I know that the COBEST Trial demonstrated improved patency of PTFE-covered stents when compared with bare metal stents in the aortoiliac territory. In view of the relatively small patient population with subclavian diseases, a randomized trial is still missing. COBEST might be point toward covered Stents, but I recommended, in this case, an individual choice. Bare metal BE Stent with high radial force because of the heavily calcified occlusion. I hope the answers will point out my strategy. Thank you for your comment!«
Case report

What should we leave behind, if we cannot leave nothing behind?

A primary ”leave-nothing-behind” approach is favored by many physicians in the treatment of femoropopliteal PAD. It remains, however, unclear which is the best treatment option when we have to leave ”something” behind. In this case the Eluvia DES was used to treat a flow limiting dissection after POBA of a long femoropopliteal CTO.

Konstantinos Stavroulakis
June 3, 2018 2 Comments
Show presentation
Comment on Jun 02, 2018

Konstantinos Stavroulakis replied to your comment on presentation Stent Graft deployment for AV Graft salvage.

»Thank you Theo for your comment! 1) Given the lack of head to head comparisons/trials only an individualized approach can be recommended. Despite the lack of data we usually try to avoid a stent deployment and we favor DCB angioplasty. The launch of DCBs up to 12mm might be useful in the treatment of central vein stenosis. On the other hand, fibrotic lesions might require a stent. A strategy that could be valuable is the use of vein dedicated stents, as the one used for the pelvic veins. Of note this strategy is not in the IFUs of these devices and we have no data at all. 2) The problem of the most vessel prep modalities is that they are all designed for the peripheral vasculature (lower extremities). Thus, they are sufficient in the treatment of vessels with a max. diameter of 7-8 mm. In this context, their use in central veins is up to now not really reasonable. However, they might provide a benefit in the treatment of AV-Fistula stenosis of the upper extremities. Again, this is only hypothetical as no study evaluated the efficacy of DAART for AV-Fistula/graft salvage.«
Case report

Endovascular lithotripsy and CO2 angiography could be valuable tools in the treatment of patients with PAD and chronic kidney disease

Chronic kidney disease (CKD) limits the outcomes of endovascular therapy in patients with PAD, while the use of contrast agent can lead to a further deterioration of the renal function. CO2 angiography and endovascular lithotripsy were used in this case in order to limit the need for nephrotoxic contrast agent in a patient with CLI and CKD.

Konstantinos Stavroulakis
May 31, 2018 No Comments
Show presentation
Case report

Remote endarterectomy: A surgical “leave nothing behind approach“

Remote endarterectomy has been suggested as a minimally invasive alternative to other established surgical approaches. In this case remote endarterectomy was performed in a patient with severe claudication of the left limb because of a CTO of the external iliac artery.

Konstantinos Stavroulakis
May 29, 2018 No Comments
Show presentation
Comment on May 26, 2018

Theodosios Bisdas commented on presentation Stent Graft deployment for AV Graft salvage.

»Excellent case Kostas! Thank you for this. I have two questions for you: 1. Which is your treatment strategy for central vein stenosis: DCB, BMS or stent-graft. If you use BMS, which one do you recommend? 2. What is the role of DAART for such ISR in AV-fistula?«
Case report

Directional atherectomy with anti-restenotic therapy for popliteal artery disease

A case of a short popliteal artery occlusion in a patient with rest pain of the right limb treated by directional atherectomy with anti-restenotic therapy (DAART) and a detailed presentation of our algorithm for the treatment of isolated popliteal atherosclerosis.

Konstantinos Stavroulakis
May 26, 2018 No Comments
Show presentation
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

Go to poll
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

Go to poll
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.

Go to poll
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

Go to poll
Poll 01/03/2019 – 31/03/2019

The chronic mesenteric ischemia

Patient’s characteristics

 

Gender: Female

Age: 69 years old

Comorbidity: Arterial hypertension, Dyslipidemia, coronary heart disease (DES deployment 2 years ago)

Symptoms:  Postprandial pain

Previous abdominal operations: None

DUS: Occlusion of the superior mesenteric artery

Go to poll
Poll 01/04/2019 – 30/04/2019

The AV access salvage procedure

Gender: Male

Age: 75 years old

Comorbidity: End-Stage Renal Disease, Diabetes, Arterial hypertension, Dyslipidemia, on hemodialysis in the last 5 years

Symptoms:  Acute occlusion of a surgically created left-sided brachial cephalic AV fistula

Go to poll
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.

Go to poll
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)

Go to poll
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!

Go to poll
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

Go to poll