Özgün Sensebat

Dr. med., MD
Vascupedian & Co-Founder of Vascupedia, Vascular and General Surgeon, Münster-Team
  • Function: Specialist
  • Speciality: Vascular Surgery
  • Country: DE
  • Working place: Private Vascular Clinic, Dorsten & Borken, DE

Activities

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. .«
Comment on Jun 19, 2018

NIKO AZHARI HIDAYAT commented on presentation Step by step ultrasound examination of varicose veins.

»Great Presentation Dr. Ozgun Sensebat, Thank's for share, in Indonesia, we are Surgeons are also keep improving and maintaining updated skills of Vascular Ultrasounds. I've had once present "Sound Easy for Surgeons", just eager to develop minds of Surgeons from "Only Cutting" to "Checking & Measuring". Best & Warm Regards from Indonesia. Niko Azhari Hidayat, Universitas Airlangga Hospital, - www.vascularindonesia.com .«
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 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

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 09, 2018

Özgün Sensebat replied to your comment on presentation Diagnostic algorithms for endoleaks.

»Prof. Verzini, Thank you for your answer. I hope that MR scans will get more and more important in the future, parallel to the regular use of non-steal grafts. Personally, I am a bit concerned about the radiogenic consequences for a patient younger than 70 y/o, who passed an EVAR procedure. Not because of the EVAR, more because of the follow-up by regular CT scans. I think the MR based follow-up will reduce this risk dramatically. Again, thank you for your answer. I hope we will join more vascular knowledge from Perugia at Vascupedia.«
Comment on Jun 09, 2018

Fabio Verzini replied to your comment on presentation Diagnostic algorithms for endoleaks.

»Dear friend Thanks for your comments. I agree with you, MR scannings of stainless steel endografts suffer from artifacts that usually render the exams unreliable. I think MR will not gain widespread use in the next future. Pts. with stainless steel endografts will decrease in the future anyway, since nowdays the vast majority of the grafts are in nitinol or cobalt-chrome.«
Comment on Jun 09, 2018

Özgün Sensebat commented on presentation Diagnostic algorithms for endoleaks.

»Dear Fabio Verzini, Thank you very much for this tremendous presentation. It is a valuable navigation-tool for everybody who treats endoleaks. One question. Which role the MR diagnosis will become for the detection and interpretation of endoleaks after implantation of stainless grafts? Do you think this technique will overtake the CT scan? 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

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!«
Comment on Jun 04, 2018

Marco Lourenco replied to your comment on presentation An off the shelf and low profile stentgraft for treatment of thoracoabdominal aneurysms.

»Dear Özgün, Thank you very much for your questions! I prepare the device at the same time, just before the surgery. I prefer the valiant thoracic device and the viabahn for the internal branches, than I've been use the viabahn or the begraft for the connection to the visceral branches. I did in the past some cases of fenestrated devices since 2004. After 2013, my first case with this technique, my preference is branched device even for juxtarenal aneurysm. Best regards Thanks again Marco«
Review of the literature

Step by step ultrasound examination of varicose veins

Which are the most important steps and technical issues that you have to keep in mind during ultrasound examination of varicose veins

Özgün Sensebat
May 8, 2018 2 Comments
Show presentation
Case report

Critical limb ischemia due to an occlusion of an aorto-biiliac prothesis

A challenging case of an occlusion of a aorto-biiliac Y graft leading to critical limb-threatening ischemia: a step by step decision making between redo laparotomy, total endovascular repair and hybrid approach. At the end follows the final treatment strategy with an analysis of all procedural steps

Özgün Sensebat
May 8, 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

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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 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 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 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

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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

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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 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 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 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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