MARTIN MARESCH

Dr.
Enthusiastic Vascular & Endovascular Surgeon has been working on the field for more than 20 years. Trained and practicing within all the areas of Vascular disorders- Aortic interventions, CLI revascularizations, carotid procedures, CHVI and DVT treatment, lymphedema management, HD access management, AV malformations. My special interest in last couple of years is Hybrid revascularizations for CLI and Venous recanalization procedures.
  • Function: Senior Consultant
  • Speciality: Vascular Surgery
  • Country: BH
  • Working place: BDF Hospital, West Riffa, BH

Activities

Comment on Jun 23, 2018

Theodosios Bisdas commented on presentation Aspiration thrombectomy for venous stent occlusion at the iliac vein.

»Thank you Martin! The lady was under LMWH due to ovarian cancer. However, I do not believe that the reason for the occlusion was the anticoagulation. The possible reasons are (1) that the first stent did not cover adequately the compressed vein or (2) there was a progression of the tumour despite the radiation or (3) it was a paraneoplastic thrombosis. In any case, we are still using LMWH in patients with cancer-associated DVT. There is some evidence of dabigatran for such patients, but I think that we need more evidence especially after stenting of the iliac veins. What is your algorithm? Finally, regarding IVUS, I cannot agree more with your comment. Fortunately, we have also IVUS now in our clinic. But the absence of clear evidence regarding the importance of IVUS does not allow reimbursement and several clinics cannot afford this type of examination. In my opinion and due to the increasing number of vein interventions, the societies of vascular surgery, interventional radiology and cardiology should focus on this issue.«
Comment on Jun 15, 2018

Michael Lichtenberg replied to your comment on presentation Revascularization of chronic iliiac vein obstruction.

»Great question Theo. I recommend to use IVUS always also after venous stent implantation to proof Aspect Ratio = 1. If AR is > 1 another post dilatation must be done to achieve good flow and long term patency (for more details see uploaded paper on lumen quality). Michael«
Comment on Jun 15, 2018

Theodosios Bisdas commented on presentation Revascularization of chronic iliiac vein obstruction.

»Dear Michael! Thank you for the nice case! What are you doing, if the IVUS shows a recoil of the stent? Repeat-PTA, Stent-in-Stent or your give time to the stent to work on the lesion? Finally, can you provide us your algorithm about anticoagulation?«
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 15, 2018

MARTIN MARESCH commented on presentation Revascularization of chronic iliiac vein obstruction.

»Nice case Michael. Can you make some comments regarding your access strategy? I would access PV or combine JV access for precise distal positioning of the stent. One more question is overlapping contralateral side since it's givving me bad dreams; you do have significant number of the cases- what is the incidence of the contralateral thrombosis as the consequence of compromised flow in your cohort? Have you considered other tactic (Oblique stent, Gianturco Z stent)?«
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.«
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 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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