Konstantinos Donas

Prof.
Professor of Vascular Surgery, Phlebologist
  • Function: Director
  • Speciality: Vascular Surgery
  • Country: DE
  • Working place: Asklepios Clinic Langen, University of Frankfurt, Langen, DE

Activities

Comment on Oct 24, 2020

Athanasios Saratzis replied to your comment on presentation VascupediaVIEWS AAA Course Episode 5: EVAR – Challenging “Renal Patient”.

»Indeed! Interesting publication which shows that stenting 4mm accessory renals when the neck is adequate is feasible. The definition of what is a "clinically relevant" accessory renal remains arbitrary though. The only way to assess what constitutes "clinically relevant" in terms of accessory renal preservation in EVAR would be randomisation; however, given how rare this clinical scenario is, we would really struggle to achieve power. I think it's a case by case judgement call... definitions will probably remain arbitrary & driven by expert opinion in this setting. To add to the complexity, assessing % of renal parenchyma supplied by a certain artery is really not very easy or accurate pre-operatively. An interesting area for future research!«
Comment on Oct 13, 2020

Konstantinos Donas commented on presentation VascupediaVIEWS AAA Course Episode 5: EVAR – Challenging “Renal Patient”.

»Thank you Dr. Beropoulis and Dr. Saratzis for the nice overview! Regarding the mentioned lack of evidence in accessory renal arteries, I would like to use the opportunity and mention the study from Dr. Abu Bakr who recommended the use of chimney grafts in ARAs which supply one-third of the renal parenchyma, and having a diameter >4 mm. The work was published in JEVT in 2016 and represents as you know, dear Efthymios, our general practice in my previous Hospital in St. Franziskus Hospital in Münster for those patients. Thank you again and best regards.«
Comment on Nov 22, 2018

Gioele Simonte replied to your comment on presentation Emergency triple chimney in a patient with giant symptomatic pararenal pseudoaneurysm and subsequent gutter embolization.

»Thank you very much Prof Donas, I'm very pleased to receive a comment on the case from a master of chimney technique like you. We used a 36 mm wide endurant graft which actually is the larger available, moreover we considered the fact that we are going to perform a triple chimney implant, thus we forecasted more than 30% oversizing (36 mm graft in 25-26 mm new neck). frankly I would pick the same sizes when facing a similar case. agree with me? Unfortunately going with more than two chimneys can lead to important gutters itself, like you already demonstrated.... About the axillary accesses probably I didn't explain clearly: we actually exposed the arteries surgically and performed a parallel double direct arterial puncture on each side (one access per vessel and one more for through and through wire). We tried in elective case axillary percutaneous access with satisfactory results but I would never perform it in an emergent case like this one«
Comment on Nov 20, 2018

Konstantinos Donas commented on presentation Emergency triple chimney in a patient with giant symptomatic pararenal pseudoaneurysm and subsequent gutter embolization.

»Great case dear Gioele, very impressive with a successful exclusion of the aneurysm. I would like to ask you if you would retrospectively have done more oversizing with the aortic stent-graft to wrap up better the 3 chimney grafts? Can you provide us an information about the degree of oversizing? I noted also that you preferred to puncture the axillary artery? How is your experience with this approach? Do you have nerve injuries and related complications? As you know we prefer to perform in general cut down. Congratulations again for the beautiful demonstration of the utility of ch-EVAR in such demanding cases.«
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.«
Review of the literature

Gutters after Chimney EVAR: How „PERICLES and PROTAGORAS“ can protect ACHILLES heel?

One of the main topics at each meeting is the discussion about the importance and clinical relevance of gutter-related endoleaks after ch-EVAR. Herein, we present you an overview of the most important causative mechanisms for the development of persistent gutters and tips to treat and minimize the risk of appearance.

Konstantinos Donas
July 1, 2018 3 Comments
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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.«
Recorded video case

Treatment of a type Ia endoleak with chEVAR: steps and materials

In this case, a type Ia endoleak after migration of a Talent endograft was treated successfully by chimney endografting. This case shows all steps of the procedure and describes the required materials (catheters, balloon catheters, bridging stent-grafts etc). The big challenges, in this case, were the angulated neck, the renal artery stenoses and the stent struts at the origin of the renal arteries.

Konstantinos Donas
May 26, 2018 1 Comment
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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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