Introduction COVID-19 is a novel coronavirus which typically results in upper respiratory symptom... more Introduction COVID-19 is a novel coronavirus which typically results in upper respiratory symptoms. However, we describe the acute arterial and venous thrombotic events following COVID-19 infection. Managing acute thrombotic events from the novel virus presents unprecedented challenges during the COVID-19 pandemic. Our study highlights the unique management of these patients and discusses the role of anticoagulation in patients diagnosed with COVID-19. Methods Data for 21 patients with laboratory confirmed COVID-19 disease and acute venous or arterial thrombosis were collected. Patients were analyzed on the basis of demographics, comorbidities, home medications, laboratory markers, and outcomes. The primary postoperative outcome of interest was mortality and secondary outcomes were primary patency and morbidity. To assess for significance, univariate analysis was performed using Pearson χ2 and Fisher exact tests for categorical variables and Student t-test for continuous variables. Results 21 patients with acute thrombotic events met our inclusion and exclusion criteria. The majority of cases were acute arterial events (76.2%) while the remainder were venous cases (23.8%). The average age of all patients was 64.6 years-old and 52.4% were male. The most prevalent comorbidity in the group was hypertension (81.0%). Several markers were markedly abnormal in both arterial and venous cases, including an elevated neutrophil: lymphocyte ratio (8.8) and d-dimer (4.9 mcg/mL). Operative intervention included percutaneous angiogram in 25.00% of patients and open surgical embolectomy in 23.8%. The majority of arterial interventions had a postoperative complication (53.9%) versus a 0% complication in the venous interventions. AKI on admission was a factor in 75.0% of mortalities versus 18.2% in survivors (p=0.04). Conclusion We describe our experience in the epicenter of the pandemic of 21 patients who experienced major thrombotic events from COVID-19. Our cohort highlights the need for increased awareness of vascular manifestations of COVID-19 and the important role of anticoagulation in these patients. More data is urgently needed to optimize treatments and prevent further vascular complications of COVID-19 infections.
The ideal treatment option for patients with complex aneurysm morphology remains highly debated. ... more The ideal treatment option for patients with complex aneurysm morphology remains highly debated. The aim of this study was to investigate the impact of endovascular aneurysm repair (EVAR) with active fixation on outcomes in patients with complex aneurysm morphology. There were 340 consecutive patients who underwent EVAR using active fixation devices, 234 with active infrarenal fixation (AIF; Gore Excluder; W. L. Gore & Associates, Flagstaff, Ariz) and 106 with active suprarenal fixation (ASF; 85 Medtronic Endurant [Medtronic, Santa Rosa, Calif] and 21 Cook Zenith [Cook Medical, Bloomington, Ind]). Demographics, comorbidities, anatomic features, and outcomes were analyzed for patients receiving devices with active fixation. Outcomes of using active fixation in necks with <15-mm neck lengths, >60-degree infrarenal neck angle (β), >30-mm infrarenal neck diameter, severe aortic neck calcification or thrombus, and nonstraight neck morphology were evaluated. Of the 340 patients, ...
INTRODUCTION This study analyzes sex-based differences in the risk of discharge to a nonhome faci... more INTRODUCTION This study analyzes sex-based differences in the risk of discharge to a nonhome facility (loss of independence) after lower extremity revascularization and resultant outcomes. METHODS Data from the NSQIP database for years 2015-2017 was utilized to assess sex-based differences in loss of independence and associated unplanned readmission and 30-day amputation using chi-square, student t-test, and multivariate logistic regression analyses where appropriate. RESULTS There was increased loss of independence in women (34.9% vs. 26.1 %, p < .01) and associated increase in unplanned readmission (18.4% vs. 13.6 %, p = .01) and length of stay (12.1 days vs 6.5 days, p < .01). Endovascular revascularization was associated with decreased likelihood of loss of independence (OR 0.43, CI 0.36-0.50). CONCLUSION Loss of independence after lower extremity bypass surgery affects women more than men and it is associated with worse postoperative outcomes.
Background: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava ... more Background: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava (IVC) filter and separate (SEP) IVC filter placement with open pulmonary thromboembolectomy (PTE) in pulmonary embolism and its clinical outcomes. Materials and Methods: From November 2006 to May 2014, 23 patients (14 females and 9 males; median age 58 years; range, 21–88 years) underwent emergent PTE for submassive (12) or massive (11) pulmonary embolism (PE). All had a preoperative computed tomography (CT) scan and echocardiography consistent with right ventricular (RV) strain. Mean cardiopulmonary bypass times and temperatures; chest tube outputs; length of stay; perioperative complications; and survival were compared between groups. Results: There were 13 patients in the SIM group and 10 in the SEP group. PE consisted of 14 acute (60.9%) and nine acute on chronic (39.1%). There were seven deaths (30.4%). Median follow up was 44 days (range, 2–2204 days). Follow up was 81% complete in...
This literature review discusses the current evidence on acute limb ischemia (ALI) in patients wi... more This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient’s clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.
Introduction COVID-19 is a novel coronavirus which typically results in upper respiratory symptom... more Introduction COVID-19 is a novel coronavirus which typically results in upper respiratory symptoms. However, we describe the acute arterial and venous thrombotic events following COVID-19 infection. Managing acute thrombotic events from the novel virus presents unprecedented challenges during the COVID-19 pandemic. Our study highlights the unique management of these patients and discusses the role of anticoagulation in patients diagnosed with COVID-19. Methods Data for 21 patients with laboratory confirmed COVID-19 disease and acute venous or arterial thrombosis were collected. Patients were analyzed on the basis of demographics, comorbidities, home medications, laboratory markers, and outcomes. The primary postoperative outcome of interest was mortality and secondary outcomes were primary patency and morbidity. To assess for significance, univariate analysis was performed using Pearson χ2 and Fisher exact tests for categorical variables and Student t-test for continuous variables. Results 21 patients with acute thrombotic events met our inclusion and exclusion criteria. The majority of cases were acute arterial events (76.2%) while the remainder were venous cases (23.8%). The average age of all patients was 64.6 years-old and 52.4% were male. The most prevalent comorbidity in the group was hypertension (81.0%). Several markers were markedly abnormal in both arterial and venous cases, including an elevated neutrophil: lymphocyte ratio (8.8) and d-dimer (4.9 mcg/mL). Operative intervention included percutaneous angiogram in 25.00% of patients and open surgical embolectomy in 23.8%. The majority of arterial interventions had a postoperative complication (53.9%) versus a 0% complication in the venous interventions. AKI on admission was a factor in 75.0% of mortalities versus 18.2% in survivors (p=0.04). Conclusion We describe our experience in the epicenter of the pandemic of 21 patients who experienced major thrombotic events from COVID-19. Our cohort highlights the need for increased awareness of vascular manifestations of COVID-19 and the important role of anticoagulation in these patients. More data is urgently needed to optimize treatments and prevent further vascular complications of COVID-19 infections.
The ideal treatment option for patients with complex aneurysm morphology remains highly debated. ... more The ideal treatment option for patients with complex aneurysm morphology remains highly debated. The aim of this study was to investigate the impact of endovascular aneurysm repair (EVAR) with active fixation on outcomes in patients with complex aneurysm morphology. There were 340 consecutive patients who underwent EVAR using active fixation devices, 234 with active infrarenal fixation (AIF; Gore Excluder; W. L. Gore & Associates, Flagstaff, Ariz) and 106 with active suprarenal fixation (ASF; 85 Medtronic Endurant [Medtronic, Santa Rosa, Calif] and 21 Cook Zenith [Cook Medical, Bloomington, Ind]). Demographics, comorbidities, anatomic features, and outcomes were analyzed for patients receiving devices with active fixation. Outcomes of using active fixation in necks with <15-mm neck lengths, >60-degree infrarenal neck angle (β), >30-mm infrarenal neck diameter, severe aortic neck calcification or thrombus, and nonstraight neck morphology were evaluated. Of the 340 patients, ...
INTRODUCTION This study analyzes sex-based differences in the risk of discharge to a nonhome faci... more INTRODUCTION This study analyzes sex-based differences in the risk of discharge to a nonhome facility (loss of independence) after lower extremity revascularization and resultant outcomes. METHODS Data from the NSQIP database for years 2015-2017 was utilized to assess sex-based differences in loss of independence and associated unplanned readmission and 30-day amputation using chi-square, student t-test, and multivariate logistic regression analyses where appropriate. RESULTS There was increased loss of independence in women (34.9% vs. 26.1 %, p < .01) and associated increase in unplanned readmission (18.4% vs. 13.6 %, p = .01) and length of stay (12.1 days vs 6.5 days, p < .01). Endovascular revascularization was associated with decreased likelihood of loss of independence (OR 0.43, CI 0.36-0.50). CONCLUSION Loss of independence after lower extremity bypass surgery affects women more than men and it is associated with worse postoperative outcomes.
Background: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava ... more Background: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava (IVC) filter and separate (SEP) IVC filter placement with open pulmonary thromboembolectomy (PTE) in pulmonary embolism and its clinical outcomes. Materials and Methods: From November 2006 to May 2014, 23 patients (14 females and 9 males; median age 58 years; range, 21–88 years) underwent emergent PTE for submassive (12) or massive (11) pulmonary embolism (PE). All had a preoperative computed tomography (CT) scan and echocardiography consistent with right ventricular (RV) strain. Mean cardiopulmonary bypass times and temperatures; chest tube outputs; length of stay; perioperative complications; and survival were compared between groups. Results: There were 13 patients in the SIM group and 10 in the SEP group. PE consisted of 14 acute (60.9%) and nine acute on chronic (39.1%). There were seven deaths (30.4%). Median follow up was 44 days (range, 2–2204 days). Follow up was 81% complete in...
This literature review discusses the current evidence on acute limb ischemia (ALI) in patients wi... more This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient’s clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.
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Papers by Ageliki Vouyouka