210 results on '"Konstantinos Spanos"'
Search Results
2. Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device
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Petroula Nana, Konstantinos Spanos, Tomasz Jakimowicz, Jose I. Torrealba, Katarzyna Jama, Giuseppe Panuccio, Fiona Rohlffs, and Tilo Kölbel
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urgent ,ruptured ,symptomatic ,complex endovascular repair ,branched devices ,off-theshelf ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
IntroductionEndovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.MethodsProspectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.Results225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I–III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p
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- 2023
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3. Dynamic Stability of Public Debt: Evidence from the Eurozone Countries
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Epameinondas Katsikas, Nikiforos T. Laopodis, and Konstantinos Spanos
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debt dynamics ,solvency ,primary balance ,panel thresholds ,Finance ,HG1-9999 - Abstract
This paper investigates the dynamic stability of public debt and its solvency condition in the face of crisis periods (1980–2021) in a sample of 11 euro-area countries. The focus is on the feedback loop between the dynamic stability of public debt and interest rates, discounted by economic growth, in conjunction with budget deficits during tranquil and turbulent periods. Using the GMM panel dynamic model, the results show that dynamic stability was the case before the global financial crisis (GFC), while from GFC to the pandemic, dynamic instability prevailed and persisted in the evolution of public debt. Furthermore, panel threshold estimates show that dynamic instability of debt starts to violate the solvency condition when the borrowing cost is above 3.29%, becomes even stronger when it is above 4.39%, and exerts even more pressure when the level of debt is greater than 91%. However, the debt sustainability condition reverses course when economic growth is higher than 3.4%. The main policy implication drawn from the results is that low interest rates can create a self-reinforcing loop of high debt, which itself is a serious matter for public authorities when designing economic policies.
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- 2023
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4. Carotid Plaque Vulnerability Diagnosis by CTA versus MRA: A Systematic Review
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Konstantinos Dakis, Petroula Nana, Chaidoulis Athanasios, Konstantinos Spanos, Batzalexis Konstantinos, Athanasios Giannoukas, and George Kouvelos
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carotid ,plaque ,intraplaque hemorrhage ,plaque ulcer ,thin-fibrous cap ,MRA ,Medicine (General) ,R5-920 - Abstract
Stenosis grade of the carotid arteries has been the primary indicator for risk stratification and surgical treatment of carotid artery disease. Certain characteristics of the carotid plaque render it vulnerable and have been associated with increased plaque rupture rates. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have been shown to detect these characteristics to a different degree. The aim of the current study was to report on the detection of vulnerable carotid plaque characteristics by CTA and MRA and their possible association. A systematic review of the medical literature was executed, utilizing PubMed, SCOPUS and CENTRAL databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. The study protocol has been registered to PROSPERO (CRD42022381801). Comparative studies reporting on both CTA and MRA carotid artery studies were included in the analysis. The QUADAS tools were used for risk of bias diagnostic imaging studies. Outcomes included carotid plaque vulnerability characteristics described in CTA and MRA and their association. Five studies, incorporating 377 patients and 695 carotid plaques, were included. Four studies reported on symptomatic status (326 patients, 92.9%). MRA characteristics included intraplaque hemorrhage, plaque ulceration, type VI AHA plaque hallmarks and intra-plaque high-intensity signal. Intraplaque hemorrhage detected in MRA was the most described characteristic and was associated with increased plaque density, increased lumen stenosis, plaque ulceration and increased soft-plaque and hard-plaque thickness. Certain characteristics of vulnerable carotid plaques can be detected in carotid artery CTA imaging studies. Nevertheless, MRA continues to provide more detailed and thorough imaging. Both imaging modalities can be applied for comprehensive carotid artery work-up, each one complementing the other.
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- 2023
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5. Cervical, anal and oral HPV detection and HPV type concordance among women referred for colposcopy
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Maria Nasioutziki, Kimon Chatzistamatiou, Panagiotis-Dimitrios Loufopoulos, Eleftherios Vavoulidis, Nikolaos Tsampazis, George-Chrysostomos Pratilas, Anastasios Liberis, Vasiliki Karpa, Evanggelos Parcharidis, Angelos Daniilidis, Konstantinos Spanos, and Konstantinos Dinas
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Anal, cervical, oral HPV concordance ,Anal HPV-detection ,Cervical HPV-detection ,Human papilloma virus ,Oral HPV-detection ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Infection with human papillomaviruses (HPVs) can cause benign and malignant tumours in the anogenital tract and the oropharynx both in men and women. The aim of the presented study was to investigate cervical, anal, and oral HPV-detection rates among women referred to colposcopy for abnormal Cervical Cancer (CaCx) screening results and assess the concordance of HPV-types among these anatomical sites. Methods Women referred to colposcopy at a single centre due to abnormal cytology, conducted for CaCx screening, were subjected to cervical Liquid-based Cytology (LBC) smear testing, anal and oral sampling. Routine colposcopy consisted in multiple biopsies and/or Endocervical Curettage (ECC). HPV-detection was performed by PCR genotyping in all three anatomical sites. In high-risk (hr) HPV-DNA positive samples either from anal canal or oral cavity, anal LBC cytology and anoscopy were performed, or oral cavity examination respectively. Descriptive statistics was used for the analysis of HPV-detection rates and phi-coefficient for the determination of HPV-positivity concordance between the anatomical sites. Results Out of 118 referred women, hr. HPV-DNA was detected in 65 (55.1%), 64 (54.2%) and 3 (2.5%) at cervix, anal canal and oral cavity respectively while low-risk HPV-DNA was detected in 14 (11.9%) and 11 (9.3%) at cervix and anal canal respectively. The phi-coefficient for cervix/anal canal was 0.392 for HPV16, 0.658 for HPV31, 0.758 for HPV33, − 0.12 for HPV45, 0.415 for HPV52 and 0.473 for HPV58. All values were statistically significant (p
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- 2020
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6. Abdominal Aortic Aneurysm Sac Alteration Depending on Initial Diameter, Endograft Material, and Presence of Endoleak Type II
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Petroula Nana, George Kouvelos, Konstantinos Spanos, Konstantinos Batzalexis, Eleni Arnaoutoglou, Athanasios Giannoukas, and Miltiadis Matsagkas
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2022
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7. A Systematic Review on PETTICOAT and STABILISE Techniques for the Management of Complicated Acute Type B Aortic Dissection
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Petroula Nana, George Kouvelos, Christian-Alexander Behrendt, Athanasios Giannoukas, Tilo Kölbel, and Konstantinos Spanos
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acute ,dissection ,type b ,bare metal stent ,stabilise ,petticoat ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Extended downstream endovascular management has been applied in acute complicated type B aortic dissection (acTBAD), distally to standard thoracic endovascular aortic repair (TEVAR), using bare metal stents, with or without lamina disruption, using balloon inflation. The aim of this systematic review was to assess technical success, 30-day mortality, and mortality during follow-up in patients with acTBAD managed with the Provisional Extension To Induce Complete Attachment (PETTICOAT) or stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement was followed. A search of the English literature, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until 30th August 2022, was executed. Randomized controlled trials and observational studies (published between 2000–2022), with ≥5 patients, reporting on technical success, 30-day mortality and mortality during the available follow-up among patients that underwent PETTICOAT or STABILISE technique for acTBAD were eligible. The Newcastle-Ottawa Scale was applied to assess the risk of bias. Primary outcomes were technical success and 30-day mortality, and secondary outcome was mortality during the available follow-up. Results: Thirteen studies were considered eligible, twelve in the quantitative analysis. In total, 418 patients with acTBAD managed with the PETTICOAT (83%) or STABILISE (17%) technique were included. Technical success ranged between 97–100%, 99% for the PETTICOAT and 100% for the STABILISE sub-cohort. Thirty-day mortality was estimated at 3.7% (12/321), 1.4% for the STABILISE and 4.4% for the PETTICOAT technique. All studies reported the mean available follow-up which was estimated at 20 months (range 3–168 months), 22 months (mean value) for the PETTICOAT and 17 months (mean value) for the STABILISE technique. Twenty-three patients died during follow-up, with an estimated mortality rate at 5.7% for the total cohort. The mortality during follow-up was 0% for the STABILISE and 7.0% for the PETTICOAT approach. Conclusions: Both, the PETTICOAT and STABILISE techniques presented less than 4% perioperative mortality in patients with acTBAD with high technical success rate. The mid-term mortality rate was at 6%. However, the heterogeneity in the available studies’ highlights the need for further prospective studies, including larger volume and longer follow-up.
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- 2023
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8. The Role of Direct Oral Anticoagulants in Cancer-Associated Thrombosis According to the Current Literature
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Petroula Nana, Konstantinos Dakis, Michail Peroulis, Nikos Rousas, Konstantinos Spanos, George Kouvelos, Eleni Arnaoutoglou, and Miltos Matsagkas
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cancer-associated thrombosis ,venous thromboembolism ,direct oral anticoagulants ,recommendations ,Medicine (General) ,R5-920 - Abstract
Venous thromboembolism (VTE) is a common complication among patients suffering from malignancies, leading to an increased mortality rate. Novel randomized trials have added valuable information regarding cancer-associated thrombosis (CAT) management using direct oral anticoagulants (DOACs). The aim of this study is to present an overview of the current literature and recommendations in CAT treatment. A few randomized control trials (RCTs) have been integrated suggesting that DOACs may be effectively applied in CAT patients compared to low molecular weight heparins (LMWHs) with a decreased mortality and VTE recurrence rate. However, the risk of bleeding is higher, especially in patients with gastrointestinal malignancies. Real-world data are in accordance with these RCT findings, while in the currently available recommendations, DOACs are suggested as a reliable alternative to LMWH during the initial, long-term, and extended phase of treatment. Data retrieved from the current literature, including RCTs and “real-world” studies, aim to clarify the role of DOACs in CAT management, by highlighting their benefits and remarking upon the potential adverse outcomes. Current recommendations suggest the use of DOACs in well-selected patients with an increasing level of evidence through years.
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- 2021
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9. Hemorrhagic Shock as a Sequela of Splenic Rupture in a Patient with Infectious Mononucleosis: Focus on the Potential Role of Salicylates
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Konstantinos Bouliaris, Dimos Karangelis, Marios Daskalopoulos, Konstantinos Spanos, Michael Fanariotis, and Anargyros Giaglaras
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Medicine - Abstract
Despite the fact that the vast majority of splenic ruptures are traumatic, infectious mononucleosis has been incriminated as a major predisposing factor that affects the integrity of the spleen, thus causing atraumatic ruptures and life-threatening hemorrhages. Herein we present a case of a 23-year-old Caucasian male who underwent an emergency laparotomy for acute abdomen and hemorrhagic shock, caused by spontaneous splenic rupture secondary to infectious mononucleosis. The potential role of salicylates in the development of a hemorrhagic complication in a patient with infectious mononucleosis is discussed.
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- 2012
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10. Midterm Outcomes of Endoleak Type 2 Embolization after Endovascular Aortic Aneurysm Repair Using a Neurointerventional Approach
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Stavros Kalliafas, Petroula Nana, Konstantinos Spanos, Nikolaos Paraskevas, and Ioannis Ioannidis
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
11. Effect of Sarcopenia on Mortality and Spinal Cord Ischaemia After Complex Aortic Aneurysm Repair: Systematic Review and Meta-Analysis
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Petroula Nana, Konstantinos Spanos, Alexandros Brotis, Dominique Fabre, Tara Mastracci, and Stephan Haulon
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
12. Conical Aortic Neck as a Predictor of Outcome after Endovascular Aneurysm Exclusion: Midterm Results
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Petroula Nana, Konstantinos Spanos, George Kouvelos, Eleni Arnaoutoglou, Athanasios Giannoukas, and Miltiadis Matsagkas
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Conical neck may affect endovascular aneurysm repair (EVAR) outcomes. The aim of this study was to present EVAR neck adverse events [endoleak type Ia (ET Ia) and graft migration], in patients with conical neck morphology compared to patients with non-conical necks. An additional analysis of the factors that may affect neck adverse events in patients with conical necks, during the initial post-operative year, was executed.A retrospective analysis of prospectively data was conducted, including patients that underwent elective EVAR, between 2017 and 2019. All patients completed the clinical and imaging follow-up of the initial 12 months. Regarding imaging, all cases underwent computed tomography angiography (CTA), preoperatively, at the 1The cohort included 150 patients; 66 (44%) presented conical neck morphology. No significant difference was detected regarding the pre-operative anatomic characteristics between the conical and non-conical groups. Only distal (15mm) neck diameter was wider in the conical group (p.001). Supra-renal active fixation was used in 63.3% of the total cohort; 59.5% in patients with non-conical necks and 68.2% in patients with conical morphology (p=.275). Graft oversizing was 18.2% and 18.7% in the non-conical and conical group, respectively (p=.248). Oversizing20% was equal between groups [37.8% vs 33.3%% (p=.608) while oversizing ≥30% was more common among patients with conical necks (3.5% vs. 10.6%, p.001, 3.2 OR, 95% CI 0.79, 12.91). Regarding ET Ia and migration, no difference was recorded between the groups. In a sub-analysis among patients with conical necks, a lower graft migration rate was detected among patients with higher oversizing rate (p=.037).EVAR may offer similarly good midterm outcomes in patients with conical and non-conical neck anatomy. An oversizing to the higher suggested rate may be preventive of graft migration during the first post-operative year in necks with conical morphology. Aggressive oversizing (20%) do not offer any benefit regarding the prevention of adverse events among patients with conical necks.
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- 2023
13. The Impact of Iliac Artery Anatomy on Distal Landing Zone After EVAR During the 12-Month Follow-Up
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Petroula Nana, Konstantinos Spanos, George Kouvelos, Konstantinos Dakis, Eleni Arnaoutoglou, Athanasios Giannoukas, and Miltos Matsagkas
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Proximal sealing zone has been the main interest in endovascular abdominal aortic aneurysm repair (EVAR), although the distal landing zone remodeling may also affect EVAR durability. The aim of this study was to assess iliac anatomy and its potential impact on distal landing zone adverse events after EVAR during the 12-month follow-up.A prospective data collection of patients treated with standard bifurcated EVAR devices for abdominal aortic aneurysm was undertaken between 2017 and 2019. Patients that received extension to the external iliac artery were excluded. Follow-up included computed tomography angiography (CTA) at the 1st and 12th month postoperatively. The common iliac artery (CIA) diameter was assessed in three levels: origin (just below the aortic bifurcation), distally (just above the iliac bifurcation) and the middle of the distance between these two landmarks. Iliac angle, tortuosity indexes, relining and oversizing were also analyzed. Distal landing zone-related adverse events were any limb related re-intervention, endoleak type Ib, graft migration, limb stenosis, or occlusion.In total, 268 iliac limbs (134 patients) were included. In all three levels, the mean iliac artery diameters increased at 12-month follow-up. At the origin of the CIA, the diameter increased from 18.7 ± 10.5 mm to 19.9 ± 9.4 mm (P = 0.04), at the middle portion of the CIA, the diameter changed significantly from 15.5 ± 5.1 mm to 17.4 ± 5.4 mm (P 0.001) and at the distal CIA, from 14.6 ± 3.3 mm to 15.1 ± 3.9 mm (P = 0.03). The iliac angle remained stable (P = 0.14) while the CIA index decreased significantly from 1.17 ± 0.13 to 1.11 ± 0.09 (P 0.001). The mean value of oversizing was 21.5 ± 14.5% and affected distal iliac diameter increase (P 0.001). The composite outcome of distal landing zone adverse events was not associated to diameter changes at any level. In 57 cases, a distal iliac diameter ≥18 mm was recorded. The estimated oversizing was lower (16.3 ± 11.8%) compared to18 mm arteries (22.5 ± 14.9%, P = 0.01). At 12-month follow-up, iliac diameters remained stable in the ≥18 mm group. Endoleak type Ib was more common in iliac arteries ≥18 mm [3 (5.3%) vs. 1 (0.5%) (P = 0.04)] at 12-months.Post-EVAR iliac artery dilation does not seem to have an impact on distal landing zone adverse events during the 12-month follow-up. Aggressive oversizing may be related to iliac dilation. EVAR patients with iliac arteries ≥18 mm are at higher risk for ET Ib.
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- 2023
14. Ascending aortic intramural hematoma: current concepts
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Petroula, Nana, George, Kouvelos, and Konstantinos, Spanos
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Blood Vessel Prosthesis Implantation ,Hematoma ,Treatment Outcome ,Acute Disease ,Endovascular Procedures ,Aortic Diseases ,Humans ,Stents ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Aorta ,Retrospective Studies - Abstract
Type A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making.Recent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affect decision making for urgent repair.Despite TAIMH's acute nature, conservative management seems to represent a valid option for urgent approach, presenting similar mortality to open and endovascular repair. Comparative data are limited, however, in experienced centers, any approach may be applied with encouraging results. Endovascular management, which is mainly applied to manage retrograde TAIMH, is related to lower mortality and morbidity compared to open repair in this group of patients while aortic remodeling seems beneficial with this approach. Imaging findings, as ulcer-like lesions, hematoma thickness, concomitant dissection and aortic diameter, related to higher complication rate, set the indication for interventional management. Further research, including prospective data and registries, and ideally, randomized data may further clarify the best approach and factors indicating urgent repair.
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- 2022
15. SGLT2 Inhibitors and Peripheral Vascular Events
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Elena Marchiori, Roman N. Rodionov, Frederik Peters, Christina Magnussen, Joakim Nordanstig, Alexander Gombert, Konstantinos Spanos, Natalia Jarzebska, and Christian-Alexander Behrendt
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
16. Endovascular treatment of aortic aneurysms and dissections in patients with genetically triggered aortic diseases
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Konstantinos Spanos, Yskertvon Kodolitsch, N. Christian Detter, Giuseppe Panuccio, Fiona Rohlffs, Ahmed Eleshra, and Tilo Kölbel
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Time Factors ,Aortic Aneurysm, Thoracic ,Endovascular Procedures ,Prosthesis Design ,Blood Vessel Prosthesis ,Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Risk Factors ,Humans ,Surgery ,Connective Tissue Diseases ,Cardiology and Cardiovascular Medicine ,Aortic Aneurysm, Abdominal ,Retrospective Studies - Abstract
Connective tissue disease (CTD) syndromes involve the ascending, aortic arch, and thoracoabdominal aorta and are associated with higher risk of aortic aneurysm or dissection. Currently, vascular societies generally recommend open repair as the first option for aortic disease in patients with CTD. However, the implementation of endovascular techniques for patients with CTD with aortic pathologies seems to have increased in recent years, mainly in patients of high surgical risk or in urgent situations. Endovascular treatment of aortic arch pathologies in patients with CTD have been feasible in experienced centers; however, the evidence is scarce. Thoracic endovascular aneurysm repair in patients with CTD is more evident; in 15 studies, 304 patients with CTD were treated with thoracic endovascular aneurysm repair with high technical success rates (88% to 100%) and a low early mortality rate (1.6%). During the median follow-up, 33 patients died and 64 patients underwent a re-intervention. In 6 studies, 26 patients with CTD were treated with fenestrated/branched endovascular aneurysm repair for thoracoabdominal aortic aneurysm, with a technical success rate of 100%, without early mortality and morbidity. The endovascular approach to thoracoabdominal aortic aneurysm, especially in post-dissection patients, mandates adjunctive techniques to achieve false lumen thrombosis with various approaches; in our experience, the Candy-Plug technique has been proven to be technically feasible with good outcomes. Endovascular treatment of aortic pathologies in patients with CTD seems to be feasible and safe in high-risk and urgent patients. Re-intervention remains an issue. The constant development of endovascular techniques and devices may provide improved mortality and morbidity outcomes.
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- 2022
17. Thirty-day mortality in females after elective and urgent abdominal aortic aneurysm repair
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Petroula NANA, Konstantinos SPANOS, Christian-Alexander BEHRENDT, Konstantinos DAKIS, Alexandros BROTIS, George KOUVELOS, Athanasios GIANNOUKAS, and Tilo KOLBEL
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
18. Sarcopenia is a Prognostic Biomarker for Long-Term Survival after Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis
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Konstantinos Dakis, Petroula Nana, Alexandros Brodis, George Kouvelos, Christian-Alexander Behrendt, Athanasios Giannoukas, Tilo Kölbel, and Konstantinos Spanos
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Male ,Sarcopenia ,Time Factors ,Endovascular Procedures ,General Medicine ,Prognosis ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Risk Factors ,Humans ,Female ,Surgery ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Aged ,Aortic Aneurysm, Abdominal - Abstract
Sarcopenia is the loss of muscle mass and strength. It manifests as decreased core muscle area in axial abdominal computed tomography scans. The predictive value of sarcopenia in outcome research has been widely discussed. A systematic review was conducted to assess sarcopenia as a biomarker in patients undergoing endovascular abdominal aortic aneurysm repair (EVAR) and its association with long-term survival.A systematic search of the English medical literature, published from 1991 to 2021, was conducted, using PubMed, EMBASE, and CENTRAL, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA, 2020) guidelines. The study protocol was registered to the International Prospective Register of Systematic Reviews (CRD 42021260192). Observational studies reporting on sarcopenic and nonsarcopenic patients undergoing EVAR were included. The Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) risk of bias evaluation tool was used for the quality assessment. The outcomes were summarized as odds ratio (OR) along with their 95% confidence intervals (CI), through a paired meta-analysis. The primary outcome was 5-year survival following EVAR.Eleven observational studies, including 2,385 patients (89.6% males) treated with EVAR, between 1999 and 2018, were included in the qualitative synthesis. The mean age was 72.9 years (range 70-76.4 years). Nine of the studies reported on a negative prognostic value of sarcopenia on survival during a long-term follow-up. Six studies stratified their cohorts in sarcopenic versus nonsarcopenic patients (40.3% sarcopenic). The cutoff values (mmThe available data derived from observational studies suggest an association between sarcopenia and worse long-term survival in patients treated with EVAR. There is a lack of a universally accepted definition for sarcopenia and future reporting standards should address this issue. Prospective studies are necessary to establish this negative prognostic value of sarcopenia on long-term survival.
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- 2022
19. Factors Associated With Noninfectious Fever After Endovascular Aortic Aneurysm Repair
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Petroula Nana, Konstantinos Spanos, Konstantinos Dakis, Christos Karathanos, George Kouvelos, and Athanasios Giannoukas
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Male ,Endoleak ,Fever ,Endovascular Procedures ,Middle Aged ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Risk Factors ,Humans ,Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine ,Aged ,Aortic Aneurysm, Abdominal ,Retrospective Studies - Abstract
Purpose: The post–endovascular abdominal aortic aneurysm repair (EVAR) inflammatory response, which is very often associated with fever, has been ascribed to a wide range of proinflammatory mediators and operative events. The aim of this study was to evaluate the impact of such factors in the development of fever of noninfectious origin after elective EVAR. Materials and Methods: A retrospective analysis of prospectively collected data of patients treated with standard elective EVAR between February 2017 and December 2020 was undertaken. The database included patients’ demographics and comorbidities, as well as laboratory inflammatory markers (white blood cell count, neutrophils, and C-reactive protein [CRP]) and anatomical characteristics (sac diameter, inferior mesenteric artery [IMA] patency and diameter, number of patent lumbar arteries, internal iliac artery [IIA] patency or occlusion). Intraoperative details, such as type of stent graft material and IIA overstenting, were also analyzed. Patients with infectious postoperative complications or previously receiving systemic anti-inflammatory medication were excluded. Statistical analysis was performed by SPSS 22.0 for Windows software (IBM Corp, Armonk, New York). Results: From 332 patients treated with elective EVAR between 2017 and 2020, 268 patients (all men) were included in the analysis. The mean age was 72.1±7.5 years and the mean aneurysm diameter was 59.1±12.1 mm. Seventeen patients were excluded due to a known infection site. From the study cohort, 114 (42.5%) patients presented with fever. Multivariate regression analysis confirmed that the occlusion of IMA ≥5 mm (pConclusion: Occlusion of an existing wide (≥5 mm) and patent IMA prior to EVAR may contribute to the development of post-EVAR pyrexia. The CRP is a reliable marker for post-EVAR fever. Further prospective studies are needed to corroborate these findings.
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- 2021
20. Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines
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Konstantinos Spanos, Petroula Nana, Yskert von Kodolitsch, Christian-Alexander Behrendt, George Kouvelos, Giuseppe Panuccio, Thanos Athanasiou, Miltiadis Matsagkas, Athanasios Giannoukas, Christian Detter, and Tilo Kölbel
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Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Aortic Aneurysm, Thoracic ,Endovascular Procedures ,Aortic Diseases ,cardiovascular system ,Humans ,Aorta, Thoracic ,Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine ,Aorta - Abstract
Background: Ascending aorta and aortic arch diseases have an increasing interest among cardiovascular specialists regarding diagnosis and management. Innovations in endovascular surgery and evolution of open surgery have extended the indications for treatment in patients previously considered unfit for surgery. The aim of this systematic review of the literature was to present and analyze current cardiovascular guidelines for overlap and differences in their recommendations regarding ascending aorta and aortic arch diseases and the assessment of evidence. Methods: The English medical literature was searched using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 2009 to December 2020. Recommendations on selected topics were analyzed, including issues from definitions and diagnosis (imaging and biomarkers) and indications for treatment to management, including surgical techniques, of the most important ascending aorta and aortic arch diseases. Results: The initial search identified 2414 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from multidisciplinary, cardiovascular societies published between 2010 and 2019. The definition of non-A-non-B aortic dissection is lacking from most of the guidelines. There is a disagreement regarding the class of recommendation and level of evidence for the diameter of ascending aorta as an indication. The indication for treatment of aortic disease may be individualized in specific cases while the growth rate may also affect the decision making. The role of endovascular techniques has not been established in current guidelines except by 1 society. Supportive evidence level in the management of aortic arch diseases remains limited. Conclusion: In current recommendations of cardiovascular societies, the ascending aorta and aortic arch remain a domain of open surgery despite the introduction of endovascular techniques. Recommendations of the included societies are mostly based on expert opinion, and the role of endovascular techniques has been highlighted only from 1 society. The chronological heterogeneity apparent among guidelines and the inconsistency in evidence level should be also acknowledged. More data are needed to develop more solid recommendations for the ascending aorta and aortic arch diseases.
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- 2021
21. Early outcomes of the t-Branch off-the-shelf multi-branched stent graft in 542 patients for elective and urgent aortic pathologies: A retrospective observational study
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Katarzyna Jama, Ahmed Eleshra, Konstantinos Spanos, Giuseppe Panuccio, Tilo Kölbel, Christian-Alexander Behrendt, Fiona Rohlffs, and Tomasz Jakimowicz
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis Design ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,Spinal Cord Ischemia ,business.industry ,Mortality rate ,Endovascular Procedures ,Stent ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Elective Surgical Procedures ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
The t-Branch, a standardized off-the-shelf multi-branched stent graft has been used for the treatment of elective and urgent cases in aortic disease. The aim of this study was to assess the early outcomes in terms of technical success, mortality, and morbidity in500 patients being treated with the t-Branch device.A two-center retrospective observational study was undertaken including patients treated using the t-Branch (Cook Medical, Bloomington, IN) in elective or urgent settings for complex abdominal aortic aneurysm and thoraco-abdominal aortic aneurysm between 2014 and 2019 (early experience 2014-2016; late experience 2017-2019). Primary endpoints were technical success and early (30-day) mortality, and secondary endpoints were early morbidity, endoleak, and target vessel patency rates. Multivariable regression models were used to determine the independent association of risk factors with (1) mortality and (2) spinal cord ischemia.A total of 542 patients (mean age, 70.5 ± 8.5 years; 388 men [72%]; mean aneurysm diameter, 7.5 ± 2.5 cm) were included (63% elective; 90% thoraco-abdominal aortic aneurysm). The technical success rate was 97% (526/542) (elective, 96.7% [328/339] vs urgent, 97.6% [208/213]). The total 30-day mortality rate was 12.3% (8.5% in elective, 15% in symptomatic, and 30% in contained rupture). After multivariate regression analysis, the mortality rate was associated with older age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.11; P .001) and with lower baseline glomerular filtration rate (OR, 0.98; 95% CI, 0.98-0.99; P .001). In elective cases, the mortality rate was associated with a history of coronary artery disease (OR, 0.26; 95% CI, 0.09-0.73; P .011) and higher body mass index (OR, 0.87; 95% CI, 0.77-0.98; P .027). In urgent cases, the mortality rate was associated with older age, (OR, 1.07; 95% CI, 1.02-1.13; P .010) and lower baseline glomerular filtration rate (OR, 0.97; 95% CI, 0.95-0.99; P .001). The spinal cord ischemia rate was 10.5% (6.5% temporary, 4% permanent) and was associated with the early study period (OR, 2.01; 95% CI, 1.03-3.89; P .038). The renal impairment rate was 13%, the stroke rate was 2.5%, and the myocardial infarction rate was 1.8%, whereas the access complications rate was 7.7%. On early computed tomography angiography, the primary patency rate for the right renal artery was 99.6%, for the left renal artery was 100%, for the superior mesenteric artery was 99.4%, and for the coeliac trunk was 99.8%. The endoleak I and III rates were 2.7% (15/542) and 2.7% (15/542), respectively.Elective and urgent use of the t-Branch multi-branched off-the shelf stent graft showed high technical success and early target vessel patency rates. Early mortality and morbidity rates were acceptable.
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- 2021
22. Risk factors and adverse events related to supra- and infra-renal aortic dilation at twelve months after endovascular abdominal aortic aneurysm repair
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Petroula NANA, George KOUVELOS, Konstantinos SPANOS, Konstantinos MPATZALEXIS, Eleni ARNAOUTOGLOU, Athanasios GIANNOUKAS, and Miltiadis MATSAGKAS
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Cardiology and Cardiovascular Medicine - Abstract
Aortic remodeling and its effect on adverse events after endovascular abdominal aneurysm repair (EVAR) remain under investigation. This study aimed to assess aortic diameter alterations after EVAR, related risk factors and consequences to proximal sealing at 12 months.A single-center retrospective analysis of consecutive EVAR patients was undertaken. All patients underwent computed tomography angiography, preoperatively, at 1A hundred fifty patients were included. At 1During the 12-month follow-up, aortic dilation may be detected from the supra-renal aorta to the total neck length. Neck dilation may be attributed to large neck diameter, supra-renal fixation, and aggressive oversizing. Neck-related adverse events are more common in patients with aortic dilation at 12 months.
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- 2022
23. Outcomes of a pilot abdominal aortic aneurysm screening program in a population of Central Greece
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Konstantinos Spanos, Petroula Nana, Nikolaos Roussas, Konstantinos Batzalexis, Christos Karathanos, Christos Baros, and Athanasios D. Giannoukas
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Cardiology and Cardiovascular Medicine - Abstract
Abdominal aortic aneurysm (AAA) screening has contributed in the decrease of aneurysm related and all-cause mortality. The objective of our study is to present our experience from the only existing pilot AAA screening program in Greece.Men from both urban and rural areas in Central Greece, aged60 years old without a previously known diagnosis of AAA were invited through the public primary health care units to participate to a screening program. Demographics, comorbidities, family history and anthropometric data were recorded. Aortic diameter values of30 mm and common iliac artery (CIA) diameter values of18 mm, were defined as aneurysmatic by ultrasound.The screening program included 1256 individuals (1256/1814; response rate 69%). The incidence of AAA and CIA aneurysm was 2% (25/1256) and 2.3% (29/1256), respectively. Increased age (P0.042), tobacco use (P0.006) and its duration (P0.008) were related to higher incidence of AAA, while diabetes mellitus to lower one (P0.048). Multivariate analysis showed that AAA was associated to longer duration of smoking (1.05, CI: 0.02-6.6; P=0.01). Statin and antiplatelet therapy were administrated in 40% (10/25) and 44% (11/25), respectively of individuals with AAA. An additional analysis was provided between subjects with AD of 25-30 mm and AD25 mm. In multivariate analysis, no factor was associated to AD of 25-30 mm.The incidence of AAA and CIA aneurysm in Central Greece is 2% and 2.3%, respectively. Smoking duration was the strongest associated factor with AAA incidence. This provides to healthcare policy makers a strong valid point for the prevention strategies.
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- 2022
24. Systematic Review on Customized and Non-customized Device Techniques for the Endovascular Repair of the Aortic Arch
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Petroula Nana, Konstantinos Spanos, Konstantinos Dakis, Athanasios Giannoukas, Tilo Kölbel, and Stephan Haulon
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Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Purpose: Open repair remains the standard of care for aortic arch pathologies. However, endovascular management became an attractive alternative for high-risk patients. This study aimed to assess the outcomes of the available endovascular techniques for aortic arch pathology management. Materials and Methods: A search of the English literature (2000–2022) using PubMed, EMBASE, via Ovid, and CENTRAL databases (February 1, 2022) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies reporting on patients with aortic arch pathologies managed with custom-made devices ([CMDs] fenestrated or branched thoracic endovascular aortic repair [F/BTEVAR]) and non-CMDs (parallel graft or surgeon-modified FTEVAR) were eligible. Studies reporting on hybrid or open repair were excluded. Studies’ quality was assessed using the Newcastle-Ottawa Scale. Primary outcomes were technical success, 30 day mortality, and cerebrovascular events (CVEs). Secondary outcomes were re-intervention and mortality during follow-up. Results: Thirty studies (2135 patients) were included. Treatment indications were mainly dissections (652 cases [48.0%, 652/1358]; 90 type A, 506 type B; 364 acute, 163 chronic) and aneurysms (46.9%, 582/1239). Five studies (211 patients) reported on FTEVAR and 10 (388 patients) on BTEVAR. For FTEVAR, technical success rate was 98.3%. Thirty-day mortality was 3.8% and CVE rate was 12.3%. Ten deaths (9.7%) and 19 re-interventions (9%) were recorded during follow-up (24 months). Regarding BTEVAR, technical success rate was 98.7%, and 30 day mortality and CVE rates were 5.4% and 11.0%, respectively. During follow-up (27 months), 64 deaths (18.7%) and 33 re-interventions (9.6%) were recorded. Parallel graft technique was reported in 11 studies (901 patients). Technical success rate was 76.4%. Thirty-day mortality was 3.9% and 32 (4.3%) CVEs were recorded. Thirty-five deaths (4.4%) and 43 re-interventions (5.5%) were reported during follow-up (27 months). Surgeon-modified FTEVAR was described in 5 studies (635 patients). Technical success rate was 91.6%. At 30 days, 15 deaths (2.3%) and 22 CVEs (3.5%) were recorded. During follow-up (19 months), 26 deaths (4.2%) and 21 re-interventions (3.6%) were detected. Conclusions: Endovascular arch repair presented a variable technical success; >95% for F/BTEVAR; ≤90% for non-CMDs. Acceptable 30 day mortality rates were reported. Cerebrovascular event rates ranged up to 10%. These findings, adjacent to the estimated midterm mortality and re-interventions, set the need for further improvement. Clinical Impact Endovascular arch repair gains popularity as a valuable alternative, especially in patients considered unfit for open repair. According the available literature, any endovascular technique, including custom-made or off-the-shelf solutions, may be applied successfully, with acceptable early mortality. However, the perio-operative cerebrovascular event rate is still an issue, indicating the need for further advancements.
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- 2022
25. Branched Endovascular Aortic Repair After a Migrated EVAR Bypassing a Severely Kinked Previous Endograft
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Jose I. Torrealba, Tilo Kölbel, Fiona Rohlffs, Konstantinos Spanos, and Giuseppe Panuccio
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Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Purpose: To describe a novel technique to repair a juxtarenal abdominal aortic aneurysm (JAAA) after failed endovascular aortic repair (EVAR) with severely kinked anatomy. Technique: We present a patient who underwent an EVAR with a Medtronic Talent device 15 years ago and a proximal cuff extension 3 years earlier for an abdominal aortic aneurysm. Computed tomography (CT) done for a known gastritis showed a 12 cm JAAA, with a migrated endograft and a type Ia endoleak (EL). Endovascular repair was performed, accessing and navigating the aneurysmal sac outside the previous graft. The type I EL was reached and the suprarenal aorta catheterized. A 4-vessel inner-branched EVAR device was deployed in the distal thoracic aorta and their target vessels bridged through femoral access. A distal bifurcated component was deployed and both iliac limbs were extended to the native distal iliac arteries. Completion angiogram as well as early and 12-month CT showed a fully patent straight course branched EVAR with no ELs. Conclusion: Complex aortic reinterventions in the presence of previous EVAR can be performed by choosing a straighter course along and parallel to the previous endograft. Several technical aspects must be considered to successfully perform this type of reinterventions. Clinical Impact We present a technique of a complex endovascular aortic repair in a failed EVAR with kinked anatomy, navigating through the thrombosed aneurysmal sac, outside the previously placed endograft and thus obtaining a straighter path for a new branched endograft. The novelty lies in a different approach to repair a failed EVAR with a branched graft through an uncommon access on the side of the previous endograft, avoiding repeated displacement or occlusion of the new endograft. We exemplify the feasibility of such a complex procedure and highlight important steps to perform it, whether in the abdominal or even thoracic Aorta.
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- 2022
26. The Association of Spondylitis and Aortic Aneurysm Disease
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Panagiotis Tasoudis, George Kouvelos, Nikolaos Patelis, Petroula Nana, Theodosios Bisdas, Konstantinos Spanos, and Alexandros G. Brotis
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Lumbar vertebrae ,030204 cardiovascular system & hematology ,Conservative Treatment ,Risk Assessment ,Endovascular aneurysm repair ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,Young Adult ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Risk Factors ,medicine.artery ,medicine ,Back pain ,Humans ,Spondylitis ,Aged ,Aged, 80 and over ,Aorta ,Aortic Segment ,Bone Transplantation ,Lumbar Vertebrae ,business.industry ,Endovascular Procedures ,General Medicine ,Middle Aged ,medicine.disease ,Osteotomy ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,cardiovascular system ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Aneurysm, Infected ,Aortic Aneurysm, Abdominal - Abstract
Objectives The aim of this study is to assess any relation between spondylitis and aortic aneurysmal disease by reviewing the current literature. Methods A systematic search was undertaken using MEDLINE, EMBASE and CENTRAL databases till May 2019, for articles reporting on patients suffering from spondylitis and aortic aneurysm. Results The most involved aortic segment was infrarenal aorta (56.9%). The lumbar vertebrae were more frequently affected (79.7%). Commonest symptoms were back pain (79.1%), fever (33.7%) and lower limb pain (29.1%). 55.8% of cases were diagnosed using computed tomography. The pathology was attributed to infectious causes in 25.1% of cases. 53.4% of patients were treated only for the aneurysm, 27.9% for both pathologies, while two patients solely for the vertebral disease. Endovascular aneurysm repair was chosen in 12.8% of cases. The 30-day mortality was 8.1% (7/86); mostly from vascular complications. Conclusions A synchronous spondylitis and aortic aneurysm may share common etiopathology, when an infectious or inflammatory cause is presented. The lumbar vertebrae are more frequently affected. Low quality data do not allow safe conclusion to suggest the best treatment option.
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- 2021
27. Antithrombotic Treatment Patterns of Patients with Symptomatic Peripheral Arterial Occlusive Disease in Germany: Evidence from Health Insurance Claims Data
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Frederik Peters, Jenny Kuchenbecker, Laura Acar, Ursula Marschall, Helmut L’Hoest, Fabien Lareyre, Konstantinos Spanos, and Christian-Alexander Behrendt
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peripheral arterial occlusive disease ,chronic limb-threatening ischaemia ,intermittent claudication ,antithrombic drugs ,health insurance claims data ,General Medicine - Abstract
Objectives: Patients with peripheral arterial occlusive disease (PAOD) are at risk of worsening limb symptoms, major adverse cardiovascular events and exhibit an impaired life expectancy. There is a lack of evidence on the extent of pharmacological secondary prevention in PAOD patients. This study assesses treatment patterns of antithrombotic agents in symptomatic PAOD patients. Methods: This is a retrospective cohort study using data from the second largest insurance fund in Germany, BARMER. We included symptomatic PAOD patients undergoing in-hospital treatment with an index admission between 1 January 2010 and 31 December 2017. Outcomes were proportions of single antiplatelets (SAPT), dual antiplatelets (DAPT), vitamin-K antagonists (VKA), or direct oral anticoagulants (DOAC) in the 12 months prior and 6 months after the index hospitalization. Non-parametric cumulative incidence for competing risks was estimated to account for censoring and death after discharge from hospital stay. Patient flows were visualised by alluvial diagrams. All analyses were stratified by intermittent claudication (IC) and chronic limb-threatening ischaemia (CLTI). The protocol was registered to ClinicalTrials.gov (NCT03909022). Results: A total of 80,426 unique patient encounters were identified. Mean age was 72.7 (46.3% female). Amongst all patients, 25.6% were on SAPT, 4.1% on DAPT, 9.1% on VKA, 3.9% on DOAC, 3.9% on both antiplatelets and oral anticoagulation, and 53.3% without any antithrombotic therapy during the 12 months before index stay. The estimated cumulative incidence was 37.9% SAPT, 14.8% DAPT, 7.5% VKA, 4.3% DOAC, 7.4% both, and 28.1% without any antithrombotic therapy during the 6 months after index stay. The considerable increases in antiplatelet therapy were mainly driven by the group of patients without antithrombotics before index stay. As compared with IC, patients who suffered from CLTI received less often antiplatelets but more often anticoagulants both before and after index stay. Conclusions: Utilisation rates of antithrombotic therapy increased considerably after in-hospital treatment for PAOD. Yet, remarkably high rates of symptomatic patients without any blood-thinning therapy constitute a major concern with respect to adequate secondary prevention of PAOD patients.
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- 2022
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28. Treatment of Aortocaval Fistula Secondary to Abdominal Aortic Aneurysm: A Systematic Review
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Konstantinos Dakis, Petroula Nana, George Kouvelos, Christian-Alexander Behrendt, Tilo Kölbel, Athanasios Giannoukas, and Konstantinos Spanos
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Aortocaval fistula (ACF) secondary to an abdominal aortic aneurysm is a rare complication, inadvertently caused by a rupture into the inferior vena cava. Different treatment modalities have been applied toward the repair of such lesions, including open surgical and endovascular repair. The aim of this study was to report on ACF treatment and to analyze its early and mid-term outcomes.A systematic search of the English medical literature published between 2000 and 2022 was undertaken, using PubMed, SCOPUS, and CENTRAL databases as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. A study protocol was registered in PROSPERO (CRD42022329058). Studies reporting on primary ACF outcomes following open surgical or endovascular repair were included. The ROBINS-I tool was applied for risk of bias assessment. Outcomes included technical success, 30-day and mid-term survival, endoleak following endovascular repair, and reintervention rates.In total, 110 case studies, incorporating 196 patients (mean age; 66.2 years, males 96%) were included. Open surgical repair was applied in 78% (153/196). From the available data, technical success rate for each modality was 99% (152/153) and 100% (43/43), respectively. Open and endovascular repair demonstrated 87.5% (126/144) and 97.6% (42/43) 30-day survival, respectively, while mid-term survival was 86% (74/86) and 95.2% (20/21), respectively (medial follow-up: 14 months [1-54 months]). Endoleaks were reported in 19 endovascular cases (39.5%). Type II endoleak was the most frequent with a rate at 32.5% (14/43). Reintervention rates were 2.5% (4/151) and 35.7% (15/42) for open and endovascular repair, respectively.Only few case studies were published on the treatment of this rare condition, while almost all invasive procedures were performed in males. Management of ACF repair with both open and endovascular approach was associated with excellent technical success rate and acceptable early and mid-term survival outcomes. Reintervention remained an issue for patients who were managed endovascularly.
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- 2022
29. Systematic review on re-intervention with fenestrated or branched devices after failed previous endovascular aortic aneurysm repair
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Petroula Nana, Tilo Kölbel, Christian-Alexander Behrendt, George Kouvelos, Athanasios Giannoukas, Stephan Haulon, and Konstantinos Spanos
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Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Proximal seal extension, after previously failed standard endovascular aneurysm repair (EVAR), has been described using various endovascular techniques. The aim of this systematic review was to assess technical success, 30-day mortality and mortality and re-intervention rates during the available follow-up, in patients managed with endovascular means for previously failed endovascular repair.This systematic review followed the PRISMA statement and was pre-registered to the PROSPERO (CRD42022350436). A search of the English literature, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until 15The initial search yielded 2,558 manuscripts. Ten studies were considered eligible; two of them were prospective. In total, 423 patients were managed with F/BEVAR after failed EVAR. The indication for re-intervention was the presence of type IA endoleak in 44.9%. Technical success was reported in seven studies and 319 interventions were considered successful (94.9%, 319/336), according to each study criteria. Ten patients died during 30-day follow-up (2.4%, 10/423). Seven cases presented spinal cord ischemia (2.4%). Twenty-three acute kidney injury events were reported (6.8%). Mean follow-up was 18 months (1-77 months). During follow-up, 47 deaths were reported (14.8%). In total, 50 re-interventions (16.5%, 50/303) were performed.According to the available literature, F/BEVAR after failed endovascular aortic aneurysm repair performed with high technical success and low mortality during the peri-operative period. Midterm mortality and re-intervention rates were acceptable. However, further data are needed to provide firm conclusions on the safety and durability of F/BEVAR after failed endovascular aortic aneurysm repair.
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- 2022
30. Fenestrated and Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysm With More Than 4 Target Visceral Vessels due to Renovisceral Arterial Anatomical Variations: Feasibility and Early Results
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Ahmed Eleshra, Nikolaos Tsilimparis, Fiona Rohlffs, Tilo Kölbel, Konstantinos Spanos, and Giuseppe Panuccio
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Male ,medicine.medical_specialty ,Prosthesis Design ,law.invention ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Celiac artery ,law ,medicine.artery ,medicine ,Humans ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Right Renal Artery ,Stroke ,Aged ,Retrospective Studies ,Computed tomography angiography ,Aged, 80 and over ,Aorta ,Aortic Aneurysm, Thoracic ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Middle Aged ,medicine.disease ,Intensive care unit ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Feasibility Studies ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose: This study describes technical success, feasibility, and early results of fenestrated and branched endovascular aortic repair (F/B-EVAR) for treatment of thoracoabdominal aortic aneurysms (TAAAs) or pararenal aneurysms with more than 4 target visceral vessels (TVs) due to renovisceral arterial anatomical variations. Materials and Methods: Patients with TAAAs or pararenal aortic aneurysms who had more than 4 TVs due to renovisceral arterial anatomical variations of renal, celiac, and/or superior mesenteric arteries and received F/B-EVAR between January 2017 and September 2019 at a single aortic center were included in this study. We analyzed technical success, feasibility, and early outcomes. Results: Twelve patients (mean age 70±10 years, 9 males) were included. The anatomical variations included 6 right accessory renal arteries, 8 left accessory renal arteries, and 1 celiac artery variant. Stent-grafts were fenestrated, branched or combined in 6, 5, or 1 patients, respectively. The mean operating time was 346±120 minutes, the mean fluoroscopy time was 80±29 minutes, and the mean radiation dose area product was 430±219 Gy·cm2. The mean contrast volume was 129±45 mL. The total number of TVs was 64; 5 TVs in 9 patients, 6 in 2 patients, and 7 in 1 patient. Technical success was achieved in all cases. The mean intensive care unit stay was 6±5 days, and the mean total hospital stay was 14±10 days. One patient died early (30-day). Early morbidities included respiratory complication in 1 patient, renal insufficiency in 1 patient, and wound infection in 2 patients. No spinal cord ischemia, stroke, or bowel ischemia occurred. Early computed tomography angiography showed 100% patency of the bridging covered stents and TVs. The mean follow-up was 13±4.3 months. No mortality or adverse major event occurred during the follow-up. Two patients with developed type Ic endoleak related to 1 right renal artery and 1 celiac artery covered stent. Patency of the TVs during follow-up was 100%. Conclusion: The use of F/B-EVAR for the treatment of TAAA with more than 4 TVs due to renovisceral arterial anatomical variations in our own experience is feasible and not related to increased morbidity and mortality.
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- 2021
31. Prospective comparative study of different endovenous thermal ablation systems for treatment of great saphenous vein reflux
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Nikolaos Rousas, Petroula Nana, Athanasios D. Giannoukas, Georgios Kouvelos, Konstantinos Spanos, Christos Karathanos, and Konstantinos Batzalexis
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Adult ,Male ,Comparative Effectiveness Research ,medicine.medical_specialty ,Time Factors ,Visual analogue scale ,Radiofrequency ablation ,Chronic venous insufficiency ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,law ,Humans ,Medicine ,Saphenous Vein ,Prospective Studies ,030212 general & internal medicine ,Aged ,Pain, Postoperative ,Radiofrequency Ablation ,business.industry ,Endovascular Procedures ,Great saphenous vein ,Reflux ,Middle Aged ,medicine.disease ,Thrombosis ,Confidence interval ,Surgery ,Treatment Outcome ,Venous Insufficiency ,Chronic Disease ,Quality of Life ,Female ,Laser Therapy ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Objective The aim of our study was to compare three different endovenous thermal ablation (EVTA) modalities in the treatment of great saphenous vein (GSV) incompetence. Methods We performed a single-center, prospective, comparative cohort study that included consecutive patients undergoing EVTA of the GSV. Patients were treated with either segmental radiofrequency ablation (sRFA) or endovenous laser ablation (EVLA) with a 1470-nm dual radial fiber or with a 1470-nm jacket-tip fiber. The clinical classification CEAP (clinical, etiologic, anatomic, pathophysiologic), 10-cm visual analog scale scores for pain, Venous Clinical Severity Scores (VCSSs), and chronic venous insufficiency quality-of-life questionnaire (CIVIQ-20) scores were recorded. The primary outcome was clinical success, which was defined as the absence of reflux or recanalization of the GSV and procedure-related complications, assessed at 7 and 30 days and 1 year postoperatively. The secondary outcomes were the assessment of postoperative pain using the VAS and improvement in the VCSSs and CIVIQ-20 scores. Results A total of 153 patients (160 limbs) had undergone sRFA (sRFA group; n = 53 limbs), 1470-nm radial fiber EVLA (EVLA-R group; n = 55 limbs), or 1470-nm jacket-tip fiber EVLA (EVLA-J group; n = 52 limbs). The patient demographics, CEAP clinical class, and intraoperative details were comparable among the three groups. The GSV occlusion rate at 1 year was 93% in the sRFA group, 93% in the EVLA-R group, and 95% in the EVLA-J group. No major complications were observed postoperatively. Endothermal heat-induced thrombosis was observed in 2 (4.4%), 1 (2.2%), and 2 (4.4%) patients in the sRFA, EVLA-R, and EVLA-J groups, respectively (P > .5). The VCSS showed greater improvement in the EVLA-R group at 1 week compared with that in the sRFA (P = .05) and EVLA-J (P = .002) groups. Changes in the CIVIQ-20 score were in favor of the EVLA-R group at 7 days (−14.3 ± 10.3 vs −7.9 ± 5.9; adjusted difference, 6.06; 95% confidence interval [CI], 1.57-10.55; P = .01) and 30 days (−12 ± 8 vs −11.2 ± 7; adjusted difference, 5.5; 95% CI, 1.21-9.81; P = .02) postoperatively compared with the sRFA group and at 7 days compared with the EVLA-J group (−14.3 ± 10.3 vs −9.6 ± 7.9; adjusted difference, −4.4; 95% CI, −9.06 to 0.22; P = .05). Analyzing the different components of the CIVIQ-20, pain, and physical scores showed a greater reduction in the EVLA-R group in the early postoperative period compared with that in the sRFA and EVLA-J groups. Conclusions All three EVTA modalities showed equal effectiveness and safety for the treatment of GSV reflux. EVLA with the 1470-nm radial fiber showed better outcomes in terms of early postoperative VCSSs and pain and physical CIVIQ scores. The clinical and quality of life benefits were similar for all modalities at 1 year postoperatively.
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- 2021
32. Regarding Comparison of Recent Practice Guidelines for the Management of Patients with Asymptomatic Carotid Stenosis
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Anne L. Abbott, Alejandro Brunser, Oliseneku D. Uyagu, Hrvoje Budincevic, Konstantinos Spanos, and Frank J. Veith
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Cardiology and Cardiovascular Medicine - Published
- 2022
33. Endovascular Treatment of a Giant Iliac Vein Aneurysm After a Traumatic Arteriovenous Fistula
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Konstantinos Spanos and Miltiadis Matsagkas
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Iliac Aneurysm ,Arteriovenous Fistula ,Humans ,Surgery ,Iliac Vein ,Vascular System Injuries ,Cardiology and Cardiovascular Medicine ,Iliac Artery - Published
- 2022
34. Impact of Conical Anatomy on Proximal Neck Adverse Events after EVAR
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Petroula Nana, Konstantinos Spanos, George Kouvelos, Metaxia Mpareka, Eleni Arnaoutoglou, Athanasios Giannoukas, and Miltos Matsagkas
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- 2022
35. Risk Factors and Adverse Events Related to Supra- and Infra-renal Aortic Dilatation after EVAR
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Petroula Nana, George Kouvelos, Konstantinos Spanos, Konstantinos Batzalexis, Metaxia Mpareka, Eleni Arnaoutoglou, Athanasios Giannoukas, and Miltos Matsagkas
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- 2022
36. Prospective comparative study evaluating the role of flavonoids after endovenous thermal ablation
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Christos Karathanos, Konstantinos Spanos, Petroula Nana, Konstantinos Batzalexis, Nikolaos Rousas, George Kouvelos, and Athanasios D. Giannoukas
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Flavonoids ,Pain, Postoperative ,medicine.medical_specialty ,business.industry ,Thermal ablation ,General Medicine ,030204 cardiovascular system & hematology ,030230 surgery ,Surgery ,03 medical and health sciences ,Treatment Outcome ,0302 clinical medicine ,Venous Insufficiency ,Chronic Disease ,medicine ,Humans ,Saphenous Vein ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,business ,Post operative pain - Abstract
Objectives The aim of our study was to evaluate the role of flavonoids in the improvement of post-operative symptoms after endovenous thermal ablation (EVTA). Methods A prospective comparative study of 120 consecutive patients undergoing EVTA of the greater saphenous vein associated with phlebectomies was undertaken. Patients were grouped in those receiving micronized purified flavonoid fraction (MPFF- 60 patients) agent 500 mg Bid 7 days pre- and 30 days post- operatively (MPFF group) and those in the control group (60 patients) who did not. Demographics, intra-operative details, Clinical –Etiology- Anatomy- Pathophysiology (CEAP) clinical class, 10-cm Visual Analog Scale (VAS) for pain, Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) were recorded. Primary outcome was the postoperative pain assessement using the VAS scale and CIVIQ pain score. Secondary outcomes included assessement of VCSS and CΙVIQ-20 scores. Results There were no significant differences between the groups regarding demographics, clinical and procedural characteristics. Patients in MPFF group reported significantly lower VAS pain levels than control group at 7- (−3.6 ± 1.2 vs −2.7 ± 1.9, p Conclusions Administration of flavonoids in patients undergoing EVTA associated with phlebectomies reduces pain by a small amount during early postoperative period.
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- 2021
37. Re: In Situ Fenestrated Thoracic Endovascular Repair Using the Upstream Peripheral Go Back™ Re-Entry Catheter From Antegrade Approach
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Konstantinos Spanos and Miltiadis Matsagkas
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Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
38. Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines
- Author
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Giuseppe Panuccio, E. Sebastian Debus, Miltiadis Matsagkas, Tilo Kölbel, Konstantinos Spanos, Christian-Alexander Behrendt, Petroula Nana, Franziska Heidemann, George Kouvelos, and Athanasios D. Giannoukas
- Subjects
medicine.medical_specialty ,Aortic Diseases ,MEDLINE ,Aorta, Thoracic ,Aortic disease ,Thoracic aortic aneurysm ,Blood Vessel Prosthesis Implantation ,Therapeutic approach ,Aneurysm ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensive care medicine ,Aortitis ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Spinal cord ischemia ,medicine.disease ,Aortic Dissection ,Dissection ,Treatment Outcome ,cardiovascular system ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cardiovascular societies have developed recommendations regarding the management of thoracic aortic diseases. While improvements in treatment have been observed during the past decade in regard to patient selection, thoracic endovascular aortic repair (TEVAR) and associated techniques, and high-volume centralization, the broad expansion of TEVAR has raised considerations about its indications, appropriateness, limitations, and application. The aim of this systematic review was to assess the similarities and differences among current cardiovascular societies’ guidelines for the management of thoracic aortic diseases. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from January 2009 to May 2020. The initial search identified 990 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from cardiovascular societies published between 2010 and 2020. Selected controversial topics were analyzed, including diagnosis, imaging, spinal cord ischemia prevention, and management of the most important thoracic aortic pathologies. The analysis included data concerning the therapeutic approach in acute and chronic type B aortic dissection, penetrating aortic ulcer, intramural hematoma, thoracic aortic aneurysm, and traumatic aortic injury, as well a discussion of inflammatory aneurysms, aortitis, and genetic syndromes. The review presents consistent and controversial recommendations, as well as “gray zone” issues that need further investigation. There was significant overlap and agreement among the 5 societies regarding the management of thoracic aortic diseases. Especially in dissection and aneurysm management, TEVAR has established its role as the treatment of choice. However, robust evidence is still needed in many aspects of the management of thoracic aortic pathologies.
- Published
- 2021
39. A new randomized controlled trial on abdominal aortic aneurysm repair is needed
- Author
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Konstantinos Spanos, Tilo Kölbel, Christian-Alexander Behrendt, George Kouvelos, and Athanasios D. Giannoukas
- Subjects
medicine.medical_specialty ,Randomized controlled trial ,business.industry ,law ,medicine ,MEDLINE ,Surgery ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Abdominal aortic aneurysm ,law.invention - Published
- 2020
40. Impact of true or false lumen renal perfusion after type B aortic dissection on renal volume
- Author
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Nikolaos TSILIMPARIS, Carlota F. PRENDES, Franziska HEIDEMANN, Ruth JACOBI, Fiona ROHLFFS, Sebastian E. DEBUS, Konstantinos SPANOS, and Tilo KÖLBEL
- Subjects
Male ,Time Factors ,Aortic Aneurysm, Thoracic ,Endovascular Procedures ,General Medicine ,Middle Aged ,Kidney ,Perfusion ,Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Creatinine ,Humans ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
The aim of this study was to analyse the influence of true, false, and combined lumen perfusion of renal arteries on mid- and long-term kidney volume in patients with type B aortic dissection (TBAD).Retrospective analysis of patients diagnosed with a TBAD between 2008 and 2015 in a single high-volume European center. The origin of the renal arteries was evaluated on a dedicated 3D workstation (TeraRecon Inc., San Mateo, CA, USA) and coded as either arising from the true lumen (TL), false lumen (FL) or from a combination of both (CL). Additional evaluated anatomical parameters were renal volume, length, width, and depth of the kidneys. Measurements were recorded at the time of diagnosis (T0) and at 1-month (T1), 6-months (T2), 18-months (T3) and 36-month of follow-up time (T4).A total of 131 renal arteries and kidneys were evaluated in 69 patients. Mean age was 64±13 years and 77% were male. The absolute number and percentage of assessed renal arteries/kidneys was 131 (100%) at T0, 89 (68%) at T1, 73 (56%) at T2, 57 (44%) at T3 and 43 (44%) at T4. At the time of diagnosis, 71.6% renal arteries originated from the TL, 19.1% from the FL and 9.2% from a CL. TEVAR was performed in 92.7% patients and nine patients had additional renal artery stenting. At T0 the mean renal volume was 212.1±70.9cmThere is a significant mid-term renal-volume reduction in patients with TBAD, independent of the origin of the renal arteries. Albeit not statistically significant, combined renal artery perfusion may lead to a greater volume reduction, potentially secondary to a relevant dynamic compression by the dissection membrane. Further multicentre studies are warranted to determine the effect on long-term renal function and on possible preventive strategies.
- Published
- 2022
41. Meta-analysis of Comparative Studies Between Self- and Balloon-Expandable Bridging Stent Grafts in Branched Endovascular Aneurysm Repair
- Author
-
Petroula Nana, Konstantinos Spanos, Alexandros Brodis, Giuseppe Panuccio, George Kouvelos, Christian-Alexander Behrendt, Athanasios Giannoukas, and Tilo Kölbel
- Subjects
Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Purpose: Currently there is no robust evidence which type of bridging stent graft provides better outcomes after branched endovascular aortic repair (BEVAR). Self-expanding (SESG) and balloon-expandable (BESG) stent grafts are both commonly used to connect branches to their respective target vessels (TV). The aim of the current review was to evaluate the impact of the type of bridging stent grafts on TV outcomes during the mid-term follow-up after BEVAR. Materials and Methods: The study protocol was registered to the PROSPERO (CRD42021274766). A search of the English literature was conducted, using PubMed and EMBASE databases via Ovid and Cochrane database via CENTRAL, from inception to June 30, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Only comparative studies on BEVAR reporting TV outcomes related to BESG vs SESG were considered eligible. Individual studies were assessed for risk of bias using the Newcastle Ottawa Scale. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of evidence. The primary outcomes were primary patency, freedom from endoleak, TV instability, and re-intervention between BESG and SESG, used as bridging stents in branches. The outcomes were summarized as odds ratio along with their 95% confidence intervals (CI), through a paired meta-analysis. Results: Five out of 609 articles published from 2016 to 2020 were included in the analysis. In total, 1406 TV were revascularized, 547 (38.9 %) with BESGs and 859 with SESGs. The overall pooled primary patency (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.29–1.09; p=.256, I2=4.24%) and freedom from branch-related endoleak (OR, 0.65; 95% CI, 0.17–1.48; p2=0.18%) did not differ between the stent types during the available follow-up (17 months, range = 12–35 months). In 4 studies (619 TV), SESG required fewer secondary interventions (OR, 1.04; 95% CI, 0.23–1.83; p=.009, I2=0%) and TV instability rate was lower (OR, 0.99; 95% CI, 0.33–1.65; p=.003, I2=0%) compared with BESG during the available follow-up. Conclusion: BESG and SESG seem to perform similarly in terms of primary patency and branch-related endoleak during the mid-term follow-up. Current data from retrospective studies suggest that overall TV instability and re-intervention rates are favorable for SESG as bridging stent grafts in BEVAR.
- Published
- 2022
42. Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection
- Author
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Konstantinos Spanos and Tilo Kölbel
- Subjects
medicine.medical_specialty ,Chronic type B dissection ,TEVAR ,business.industry ,Type B aortic dissection ,False lumen ,Review ,Remodeling ,Surgery ,Endovascular repair ,Occlusion ,cardiovascular system ,Medicine ,Open repair ,Radiology, Nuclear Medicine and imaging ,In patient ,High surgical risk ,cardiovascular diseases ,Inner branch device ,Cardiology and Cardiovascular Medicine ,business - Abstract
In recent guidelines of international societies, the most frequent indication for treatment after chronic type B aortic dissection (cTBAD) is aneurysmal dilatation. Endovascular repair is recommended in patients with moderate to high surgical risk or with contraindications to open repair. During the last decade, many advances have been made in the field of endovascular techniques and devices. The aim of this article is to address the current status of endoluminal techniques for the management of cTBAD including standard thoracic endovascular repair, new devices, fenestrated and branched abdominal aortic devices and false lumen occlusion techniques. Electronic supplementary material The online version of this article (10.1007/s00270-020-02566-7) contains supplementary material, which is available to authorized users.
- Published
- 2020
43. Technical Aspects of Branched Thoracic Arch Graft Implantation for Aortic Arch Pathologies
- Author
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Fiona Rohlffs, Nikolaos Tsilimparis, Giuseppe Panuccio, Konstantinos Spanos, Tilo Kölbel, and Franziska Heidemann
- Subjects
Aortic arch ,Time Factors ,business.industry ,Endovascular Procedures ,Aortic Diseases ,Aorta, Thoracic ,Anatomy ,Aortic arch aneurysm ,Prosthesis Design ,Blood Vessel Prosthesis ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Treatment Outcome ,Risk Factors ,medicine.artery ,medicine ,Humans ,Stents ,Radiology, Nuclear Medicine and imaging ,Surgery ,Common carotid artery ,Arch ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose: To describe the implantation steps and tips and tricks for the Inner Branch Arch Endograft designed to treat aortic arch aneurysm and chronic type A aortic dissection. Technique: Anatomical suitability criteria should be met in order to use this device. The proximal segment of the graft lands in the ascending aorta distally to the sinotubular junction and the distal segment lands in the descending aorta. The device includes 2 inner branches; the proximal branch is used for a connection to the innominate artery (positioned slightly posterior at 12:30 o’clock), while the second branch is positioned slightly anterior at 11:30 o’clock and is used as a connection to the left common carotid artery. Access, implantation technique, deployment of the device, and catheterization of the branches are described thoroughly. Conclusion: This Inner Branch Arch Endograft is an appealing alternative to treat aortic arch pathology, especially in patients unsuitable for open repair. Nevertheless, complex aortic arch repair is associated with a learning curve. Meticulous preoperative planning and a high level of concentration intraoperatively are mandatory.
- Published
- 2020
44. A Systematic Review on PETTICOAT and STABILISE Techniques for the Management of Complicated Acute Type B Aortic Dissection
- Author
-
Konstantinos Spanos, Tilo Kölbel, Athanasios Giannoukas, Christian-Alexander Behrendt, George Kouvelos, and Petroula Nana
- Subjects
General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
45. Τhe AFX unibody bifurcated unibody aortic endograft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives
- Author
-
Athanasios D. Giannoukas, Georgios Ioannidis, Efstratios Georgakarakos, Andreas Koutsoumpelis, Nikolaos Papatheodorou, George S. Georgiadis, Christos Argyriou, and Konstantinos Spanos
- Subjects
medicine.medical_specialty ,Biomedical Engineering ,030204 cardiovascular system & hematology ,Prosthesis Design ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Endoskeleton ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,Thrombus ,Polytetrafluoroethylene graft ,Fixation (histology) ,Aorta ,business.industry ,Hemodynamics ,General Medicine ,Aortic bifurcation ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,medicine.anatomical_structure ,Cuff ,business ,030217 neurology & neurosurgery ,Aortic Aneurysm, Abdominal - Abstract
Introduction: AFX is a bifurcated unibody aortic endograft for the treatment of Abdominal Aortic aneurysms. It consists of an inner metallic endoskeleton with multiple metallic struts covered by a polytetrafluoroethylene graft fabric. The endoskeleton is sutured to the outer fabric only at the proximal and distal ends. The unique design of AFX aims at fixation onto the aortic bifurcation while a proximal cuff ensures sealing at the infrarenal level.Areas covered: Since this endograft design by Endologix has undergone significant changes over the last years, the aim of this article is to present its unique structure and deployment method and discuss the relevant clinical results as well as reported complications and associated concerns.Expert commentary: the AFX stent-graft exhibits very satisfactory clinical mid-term results in abdominal aortic aneurysms treated within the instructions-for-use. Its 'active-seal' concept of infrarenal fixation stemming from the loose conjugation of the fabric material to the endoskeleton can accommodate efficiently to challenging necks with thrombus or morphological irregularities, thereby extending the anatomical sealing zone without exerting significant radial outward force. Long-term results are needed to validate the promising performance of AFX.
- Published
- 2019
46. Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy
- Author
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Fiona Rohlffs, Tilo Kölbel, Ahmed Eleshra, Catharina Gronert, Konstantinos Spanos, and Giuseppe Panuccio
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Stent ,medicine.disease ,Surgery ,Aortic aneurysm ,medicine.anatomical_structure ,medicine.artery ,medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Renal artery ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Purpose: To present a case of endovascular repair using a custom-made 7-branch stent-graft for a thoracoabdominal aortic aneurysm (TAAA) in a patient with variations in the renovisceral artery anatomy. Case Report: A 70-year-old asymptomatic man presented with a 60-mm-diameter type IV TAAA. Due to severe coronary artery disease, an endovascular approach was elected. In the preoperative computed tomography angiography (CTA) scans, variations in the renovisceral artery anatomy included the common hepatic and splenic arteries deriving separately from the aorta and bilateral double renal arteries (RAs). A custom-made 7-branch stent-graft was manufactured to preserve all renovisceral arteries. The 7 branches were catheterized and connected with a steerable sheath from a femoral access. All branches were bridged to the target vessel (TV) with a self-expanding covered stent; 4 TVs also had balloon-expandable covered stents implanted. Final angiography and predischarge CTA showed patency of all 7 target vessels and corresponding visceral organs, with no endoleak. The patient was discharged on postoperative day 8 without complications. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 7 target vessels. Conclusion: Successful treatment of a TAAA in a patient with multiple variant renovisceral arteries was feasible with a custom-made 7-branch stent-graft, achieving a good early outcome.
- Published
- 2019
47. Carotid Intima-Media Thickness and Circulation Markers of Inflammation in Patients With Depression
- Author
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Nicos Labropoulos, Konstantinos Spanos, Angelos Halaris, Maria Papaliaga, George Kouvelos, Vasileios Saleptsis, and Athanasios D. Giannoukas
- Subjects
Carotid atherosclerosis ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Inflammation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Intima-media thickness ,medicine.artery ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,In patient ,Common carotid artery ,medicine.symptom ,Risk factor ,business ,030217 neurology & neurosurgery ,Depression (differential diagnoses) - Abstract
Objective: Growing evidence indicates that depressive disorders (DDs) are an important risk factor for atherosclerosis. The aim of this study was to evaluate the presence of common carotid artery (CCA) intima-media thickness (IMT) and circulation inflammation markers in patients with DD. Methods: A cross-sectional prospective study was undertaken comparing 40 patients with DD to 40 individuals free of depression, matched for age and gender. The Beck Depression Inventory questionnaire, serum total cholesterol, triglycerides, high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor α, P-selectin, and E-selectin levels were measured. The CCA-IMT was assessed with duplex sonography. Results: Patients with DD were more likely to smoke (65% vs 40%; P = .03) and have higher levels of serum total cholesterol (211 mg/dL vs 181 mg/dL; P = .010), triglycerides (138 mg/dL vs 97 mg/dL; P = .005), and P-selectin (0.87 ng/mL vs 0.61 ng/mL; P = .05) and lower levels of interleukin 6 (4.4 ± 2.1 pg/mL vs 10.3 ± 1.1 pg/mL; P = .002). The CCA-IMT was similar in both groups (0.07 ± 0.02 cm vs 0.06 ± 0.01 cm; P = .31). Among those with CCA-IMT in the upper quartile, subjects in the DD group had lower levels of interleukin 6 ( P = .05) and triglycerides ( P = .01) and higher levels of soluble P-selectin ( P = .03). Conclusion: Patients with DD do not present with higher CCA-IMT than a control group, although smoking and a higher level of serum lipids are present. Inflammatory biomarkers seem to be higher in patients with DD.
- Published
- 2019
48. Systematic review on transcaval embolization for type II endoleak after endovascular aortic aneurysm repair
- Author
-
Petroula Nana, Konstantinos Spanos, Franziska Heidemann, Giuseppe Panuccio, George Kouvelos, Fiona Rohlffs, Athanasios Giannoukas, and Tilo Kölbel
- Subjects
Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Endoleak ,Endovascular Procedures ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Embolization, Therapeutic ,Aortic Aneurysm ,Aortic Aneurysm, Abdominal ,Retrospective Studies - Abstract
A persistent endoleak type II (ET II) after endovascular repair for aortic aneurysms is not always a benign condition and has been associated to sac expansion, rupture, and reintervention. A variety of different endovascular approaches are available for ET II treatment. The aim of this systematic review was to assess the currently available literature on transcaval embolization for ET II treatment after standard or complex endovascular aortic aneurysm repair.This systematic review protocol was registered to the PROSPERO (CRD42021289686). The PRISMA guidelines and patient, intervention, comparison, outcome (P.I.C.O.) model was followed. A data search of the literature was conducted, using PubMed, EMBASE via Ovid, and CENTRAL databases, until September 30, 2021. Only studies reporting on ET II embolization using the transcaval approach after endovascular aneurysm repair were included. Studies reporting on different type of endoleak treatment or any other embolization approach were excluded. The quality of studies was assessed using the Newcastle-Ottawa Scale. Primary outcomes were technical success and freedom from ET II persistence during follow-up; secondary outcomes were any postoperative complication associated with the transcaval embolization and need for reintervention.The search yielded 2861 articles in total. Eight articles were included, reporting on 117 patients and 128 transcaval embolizations. The indication for treatment was ET II presence with sac expansion of more than 5 mm; in two studies, the presence of persistent endoleak has set the indication to intervene. The technical success was 91.4% (117/128); a variety of embolic materials were used, including coils, thrombin, and glue. Three cases of deep vein thrombosis were recorded and the remaining morbidity and mortality were null. Follow-up was ranging between 0 and 25 months. Out of 8 studies, persistent ET II rate was 12.8% and 18 reinterventions were performed (14.1%,), including 10 transcaval coil embolizations (56%). Sac expansion was reported in 11 cases, out of 3 studies (17%). Only one case of death, not associated with transcaval embolization, was recorded.Transcaval embolization for ET II treatment presents a high technical success and low mortality in the early and mid-term period. ET II persistence rate is low during the available 12-month follow-up.
- Published
- 2021
49. Non-Standard Management of Target Vessels With the Inner Branch Arch Endograft: A Single-Center Retrospective Study
- Author
-
Tilo Kölbel, Giuseppe Panuccio, Nikolaos Tsilimparis, Thomas Gandet, Jose Torrealba, Fiona Rohlffs, Konstantinos Spanos, and Franziska Heidemann
- Subjects
Aortic arch ,medicine.medical_specialty ,Time Factors ,Aortic Aneurysm, Thoracic ,Endoleak ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,Aorta, Thoracic ,Single Center ,Surgery ,Blood Vessel Prosthesis ,Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,medicine.artery ,medicine ,Left subclavian artery ,Humans ,Radiology, Nuclear Medicine and imaging ,Arch ,Cardiology and Cardiovascular Medicine ,business ,Retrospective Studies - Abstract
Purpose: The purpose of this study was to evaluate early and mid-term results of non-standard management of the supraaortic target vessels with the use of the inner branch arch endograft in a single high-volume center. Material and methods: A single-center retrospective study including all patients undergoing implantation of an inner branch arch endograft from December 2012 to March 2021, who presented a non-standard management of the supraaortic target vessels (any bypass other than a left carotid-subclavian or landing in a dissected target vessel). Technical success, mortality, reinterventions, endoleak (EL), and aortic remodeling at follow-up were analyzed. Results: Twenty-four patients were included. In 17 (71%) cases, the non-standard management was related to innominate artery (IA) compromise (12 with IA dissection, 2 with short IA, 2 with short proximal aortic landing zone that required occlusion of IA, 1 with occluded IA after open arch repair). Two (8%) cases were related to an aberrant right subclavian artery (RSA), 1 patient (4%) due to the concomitant presence of a left vertebral artery (LVA) arising from the arch and an occluded left subclavian artery (LSA), and another patient presented with an occluded LSA distal to a dominant vertebral artery. Three (13%) cases were exclusively related to management in patients with genetic aortic syndromes. Twenty (83%) patients had a previous type A aortic dissection. Ten (42%) patients presented a thoracic or thoracoabdominal aortic aneurysm and 8 (33%) patients an arch aneurysm, 6 of them associated to false lumen (FL) perfusion. There were 2 (8%) perioperative minor strokes, and 1 patient with perioperative mortality. Seven patients presented an early type I endoleak, all resolved at follow-up. Seven patients required reinterventions during follow-up (7 reinterventions related to continuous false lumen perfusion, 3 related to Type Ia endoleak, 2 related to surgical bypass). All patients who presented with FL perfusion had complete FL thrombosis at follow-up. No patient presented aneurysm growth at follow-up. Conclusions: The use of the inner branch arch endograft with a non-standard management of the supraaortic target vessels is a possible option. Despite a high reintervention rate, regression or stability of the aneurysmal diameter was achieved in all the patients with follow-up.
- Published
- 2021
50. Προαγωγή υγείας και συμμετοχή σε προγράμματα άσκησης
- Author
-
Konstantinos Spanos
- Abstract
Oι βασικότεροι παράγοντες που επηρεάζουν την κατάσταση της υγείας των ατόμων είναι ο τρόπος ζωής τους, δηλαδή η διατροφή, η φυσική δραστηριότητα καθώς και το περιβάλλον που ζουν και εργάζονται. Το είδος αλλά και οι συνθήκες εργασίας μπορούν να επιφέρουν αρνητικές επιδράσεις στην υγεία των εργαζομένων, γεγονός που συντελεί σε μειωμένη αποδοτικότητα και εργασιακή αποχή. Σκοπός της παρούσας έρευνας ήταν να καταγράψει συμπεριφορές εργαζομένων που διάγουν καθιστική εργασία. Επίσης στόχος ήταν να ανακαλύψει κατά πόσο σχετίζεται το εργασιακό στρες, η επαγγελματική ικανοποίηση και η επαγγελματική εξουθένωση με την εργασιακή αποχή, τη φυσική κατάσταση, τη σωματική σύσταση και τις συμπεριφορές που σχετίζονται με την υγεία. Για τη στατιστική ανάλυση χρησιμοποιήθηκε περιγραφική στατιστική, t-test, one-way ANOVA, MANOVA, post hoc test, μέθοδος PCA- ανάλυση κύριων συνιστωσών και η εφαρμογή μοντέλου δομικών εξισώσεων. Τα αποτελέσματα έδειξαν πως το φύλο, η ηλικία, η σωματική σύσταση, ο τομέας και η θέση εργασίας, καθώς και η βαθμίδα εκπαίδευσης επηρεάζουν σημαντικά τους παράγοντες του εργασιακού άγχους, της επαγγελματικής ικανοποίησης και της επαγγελματικής εξουθένωσης. Επιπρόσθετα, το εργασιακό άγχος επηρεάζει αρνητικά την αποδοτικότητα, ενώ η επαγγελματική ικανοποίηση επιδρά θετικά στη μείωση της εργασιακής αποχής. Η άσκηση φαίνεται να επιδρά θετικά στην αποπροσωποίηση, ενώ η αυξημένη μέγιστη πρόσληψη οξυγόνου, η μέγιστη δύναμη και τα χαμηλά επίπεδα σωματικού λίπους αυξάνουν σημαντικά την αποδοτικότητα και μειώνουν την εργασιακή αποχή. Τα αποτελέσματα φανερώνουν πως η βελτίωση της υγείας των ανθρώπων στον χώρο εργασίας, μπορεί να αποτελέσει σημαντικό έναυσμα για την υιοθέτηση πιο θετικών συμπεριφορών και μείωση της νοσηρότητας μέσω ειδικών προγραμμάτων βελτίωσης της ποιότητας ζωής στους εργασιακούς χώρους. Η άσκηση, το χαμηλό ποσοστό σωματικού λίπους και οι υγιεινές συμπεριφορές μπορούν να επηρεάσουν θετικά την παραγωγικότητα των εργαζομένων και συνολικά ολόκληρων των οργανισμών.
- Published
- 2021
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