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C D Liapis

Publications and source records attributed to C D Liapis.

36 records · Page 2Linked to original sources
PubMed2002

The impact of the carotid plaque type on restenosis and future cardiovascular events: a 12-year prospective study.

OBJECTIVES: to evaluate the impact of the carotid plaque type on recurrent carotid stenosis, future cardiovascular events and patients' survival. DESIGN: open prospective study. PATIENTS AND METHODS: three hundred and eight patients who underwent a total of 338 carotid endarterectomies were included in the study. All of the patients were evaluated postoperatively with clinical examination and colour duplex 1 month after the operation and every 6 months thereafter. Mean duration of follow-up was 63 months (range: 12-144). Eight patients (3%) were lost to follow-up. Restenoses, cardiovascular events and deaths were recorded and analysed with regard to the traditional risk factors and the ultrasonographic characteristics of the plaques. Statistical analysis was performed using the Kaplan-Meier method, the log rank test and Cox regression analysis. RESULTS: cumulative restenosis rate at 10 years of follow-up was 21% and was associated with coronary artery disease (p=0.01) and echolucent plaques (p=0.02). Life-table analysis showed a 10-year survival rate of 64% and a 10-year rate of cardiovascular events of 41%. Hypertension (p=0.003), coronary artery disease (p=0.002) and echolucent plaques (p=0.01) were associated with a higher incidence of cardiovascular events.

Adult↗
PubMed2002

Low molecular weight heparins in the long-term treatment of venous thromboembolism.

Low molecular weight heparins (LMWHs) have extensively replaced unfractionated heparin (UFH) in both thromboprophylaxis and initial treatment of venous thromboembolism (VTE) and their use for such indications is now well established. This paper reviews the role of LMWHs in the long-term treatment of VTE. Venous thrombosis, although a very frequent occurrence in everyday practice, still remains controversial in its treatment. Available literature comparing different LMWHs with UFH and oral anticoagulants (OAs) is presented. Comparison and evaluation of the effectiveness, safety and costs of alternative treatments are also made. The differences of various LMWHs are discussed and the need for separate clinical trials for every single LMWH is highlighted.

Anticoagulants↗
PubMed2001

Carotid stenosis: factors affecting symptomatology.

BACKGROUND AND PURPOSE: The ability to predict future strokes in asymptomatic patients with carotid stenosis is currently limited. The management of symptomatic patients with <50% stenosis is also debatable. In this context, we performed the following open prospective study to identify factors affecting symptomatology in patients with carotid stenosis. METHODS: During 1988-1997, 442 arteries with various degrees of stenosis were followed with the use of color Duplex ultrasonography every 6 months. The main outcome measures were development of symptoms related to the carotid territory and progression in the degree of stenosis. Results of follow-up were analyzed in relation to the traditional risk factors for atherosclerosis as well as the ultrasonographic characteristics of the plaques. Statistical analysis was performed by multiple linear and Cox regression analysis. RESULTS: Mean duration of follow-up was 44 months (range, 12 to 120 months). Significant progression of stenosis occurred in 18.5% of the cases and was more frequent in younger patients (P=0.09), in patients with coronary artery disease (P=0.02), and in patients with echolucent plaques (P=0.02). In regard to clinical presentation, men (P=0.07), hypertensives (P=0.07), and patients with echolucent plaques (P=0.09) showed a trend toward higher frequency of stroke in their history. During the follow-up period, neurological events developed in 12.4% of the cases and were associated with the severity of carotid disease (P<0.001), history of neurological events (P=0.02), progression of stenosis (P=0.002), echolucent plaques (P=0.01), and hypertension (P=0.02). CONCLUSIONS: Factors other than degree of stenosis and history of neurological events are also important in determining high-risk carotid plaque. In our study hypertension, echolucent plaques, and progressive lesions were associated with an increased risk of neurological events. These factors should be taken into consideration in determining treatment strategies for carotid stenosis.

Carotid Stenosis↗
PubMed2001

Recurrent carotid artery stenosis: natural history and predisposing factors. A long-term follow-up study.

BACKGROUND: The aim of this study was to evaluate the impact of various risk factors, excluding the type of closure of the arteriotomy, on the development of recurrent carotid stenosis after carotid endarterectomy. TYPE OF STUDY: single-center, open prospective. METHODS: Three hundred and eight patients, who underwent a total of 338 carotid endarterectomies, were evaluated postoperatively with color duplex 1 month after the operation and every 6 months thereafter, the mean duration of follow-up being 52 months (range: 6-144). Only patients submitted to primary closure of the arteriotomy were included. Statistical analysis was performed using the Kaplan Meier method, the log rank test and Cox regression analysis. RESULTS: Three patients (0.9%) died during the perioperative period. Three (0.9%) patients had a transient ischemic attack and 7 (2.1%) a nonfatal stroke. Recurrent carotid stenosis of >50% was identified in 11 patients, leading to a 21.6% cumulative restenosis rate at 10 years of follow-up. Only one of the 11 patients with restenosis developed neurological symptoms during the follow-up period. Both univariate and multivariate analyses showed that coronary artery disease was significantly associated with restenosis, while patients with uniformly echogenic plaques as well as those with hypercholesterolemia showed a lower incidence of restenosis. CONCLUSIONS: The cumulative recurrent stenosis rate following carotid endarterectomy was 21.6% at 10 years of follow-up. Restenosis was symptomatic in 1 patient. Coronary artery disease was associated with an increased risk of restenosis, while uniformly echogenic plaques and hypercholesterolemia were associated with a lower risk.

Adult↗
PubMed2000

Role of malignancy and preoperative embolization in the management of carotid body tumors.

The purpose of this retrospective study is to present our approach to the management of patients with carotid body tumors (CBTs), emphasizing the role of malignancy and preoperative embolization. Between 1975 and 1998 a series of 18 patients with CBTs were treated, and 16 of them underwent successful excision of the tumor. According to the Shamblin classification, six of the tumors were type I, six type II, and six type III. In three of these patients (two with type II tumors and one with type III) in whom preoperative embolization had been performed, mean intraoperative blood loss was 400 ml, whereas in the remaining 13 cases this loss was 700 ml. Two patients with intracranial tumor spread underwent only radiotherapy. Neither postoperative deaths nor strokes occurred. Temporary cranial nerve injury occurred in four cases (25%). Local lymph node invasion was found in two patients, establishing the diagnosis of malignancy. One of these patients developed distal metastases 3 years after the operation and was treated with radiotherapy and octreotide. Follow-up ranging from 30 months to 23 years (mean 5 years) revealed no local recurrence except for the two patients who were treated with radiotherapy only. In conclusion, surgical excision remains the treatment of choice for CBTs and can be performed without major risks and with low morbidity and mortality. Preoperative embolization is helpful by diminishing intraoperative bleeding, and malignancy, though rare justifies early management.

Adult↗
PubMed1994

Surgical treatment of extracranial carotid aneurysms.

During the past 23 years, 12 patients with aneurysm of the carotid bifurcation were treated in our department. There were 11 men and one woman between 20 and 68 years (mean age 54.2 years). In as much as 217 patients were operated on for extracranial occlusive carotid disease during the same period, the incidence of these aneurysms in our series has been estimated to be 5%. Eleven patients presented with TIAs ipsilateral to the aneurysm. One patient presented with a painful pulsatile enlarging mass in the neck (ruptured aneurysm) without any neurological complications. Eleven patients underwent surgical repair. Ligation of the common carotid artery was done in one patient, resection of the aneurysm with end-to-end anastomosis was performed in 2 patients, aneurysmorraphy in 4, excision and reconstruction with reversed saphenous vein in one, excision and reconstruction with PTFE graft in one and 2 patients underwent endarterectomy and angioplasty of the carotid bifurcation. One patient with a high internal carotid artery aneurysm (base of the skull) was classified as nonoperable. There were no deaths or strokes postoperatively. Persistent cranial nerve injury was noted in 1 case (8%). Follow-up at 6 months - 10 years (mean 5.5 years) yielded and incidence of post-op TIAs of 8% attributed to intracranial occlusive disease. Surgical correction is the treatment of choice for extracranial carotid aneurysm and can be performed with a very low morbidity and mortality and carries excellent long-term results.

Blindness↗
PubMed1982

Prospective randomized study of concomitant lumbar sympathectomy with aortoiliac reconstruction.

Ninety-three consecutive patients for aortofemoral bypass grafting were studied to determine the effect of sympathectomy on early and late patency, the need for subsequent distal procedures, amputation rate, and ankle-brachial Doppler systolic pressure indexes. Sixty-seven patients completed the study. Fifty-three limbs were randomized to receive sympathectomy and 81 no sympathectomy. The mean length of follow-up postoperatively was 11 +/- 2.53 months (maximum 24). Five grafts occluded, two early and three late. Both early occlusions occurred in the nonsympathectomy group and all three late occlusions ensued in the sympathectomy group. Subsequent distal procedures were necessary early (within 30 days) in five limbs, all in the nonsympathectomy group. Nine limbs required distal procedures late, four (5 percent) in the nonsympathectomy group and five (9.5 percent) in the sympathectomy group (p greater than 0.05). Altogether, distal bypass was required in 11 percent of the patients in the nonsympathectomy group versus 9.4 percent in the sympathectomy group (p greater than 0.05). Five limbs were amputated 4 to 14 months after aortofemoral bypass, four (5 percent) in the nonsympathectomy and one (2 percent) in the sympathectomy group (p greater than 0.05). The ankle-brachial pressure index increased significantly after aortofemoral bypass in both groups (p less than 0.05). The mean increase after aortofemoral bypass was more marked in the sympathectomy group (p greater than 0.05). Thus, at a mean follow-up time of 11 months after aortofemoral bypass, there was no significant difference in graft patency, need for subsequent distal bypass, or amputation rate between the sympathectomy and nonsympathectomy groups.

Adult↗
PubMed1982

Effect of the pH of cardioplegic solution on postarrest myocardial preservation.

The assumption that an alkaline cardioplegic solution is advantageous to the arrested heart is not supported by experimental evidence. Three groups of dogs were subjected to 2 hours of hypothermic arrest using a potassium cardioplegic solution of varying pH: group 1 (n = 8), pH 7.1; group 2 (n = 6), pH 7.4; and group 3 (n = 8), pH 7.7. Left ventricular (LV) function curves were obtained before arrest and after reperfusion, and the percent recovery of LV function was calculated. Coronary blood flow (CBF), oxygen and lactate use, and adenosine triphosphate and creatine phosphate were measured before and after arrest. Recovery of LV function was 83 +/- 4% (mean +/- SEM) in group 1 and 75 +/- 6% in group 2. LV function in group 3 was significantly depressed at 51 +/- 5% (p less than 0.01). Immediately after arrest, CBF and oxygen consumption were lowest in group 1 and highest in group 3 (p less than 0.01). CBF increased 23 +/- 9% in group 1, 110 +/- 29% in group 2 and 277 +/- 33% in group 3. Oxygen consumption was 2.2 +/- 0.4 vol/100 g/min in group 1, 3.63 +/- 0.5 vol/100 g/min in group 2 and 4.63 +/- 0.7 vol/100 g/min in group 3. All groups showed postarrest depression of adenosine triphosphate and creatine phosphate, but return of creatine phosphate to control was slowest in group 1 (p less than 0.01). These results indicate no advantage to an alkaline cardioplegic solution and suggest that an acidic cardioplegic solution, by inhibiting metabolism, may increase protection of the arrested heart.

Adenosine Triphosphate↗
PubMed1981

Aortofemoral bypass for severe limb ischemia. Long-term survival and limb salvage.

Long-term survival, graft patency and limb salvage in 74 patients with 96 severely ischemic limbs after aortofemoral bypass grafting is presented. Results in 73 limbs reconstructed for rest pain and 23 limbs reconstructed for ulceration or gangrene were compared by life table analysis, with follow-up of up to 98 months. The operative mortality was 4 percent. Overall 5 and 8 year survival was 74.8 and 52.3 percent, respectively. Overall graft patency at 5 years was 80.8 percent (rest pain 74.4 percent versus ulceration or gangrene 100 percent). Overall limb salvage was 76.7 percent at 5 years (rest pain 83 percent versus ulceration or gangrene 55 percent) (p < 0.001) and 68 percent at 8 years. Distal reconstructions were necessary in 19 limbs (21 percent); limbs with ulceration or gangrene required further attempts at salvage more often (34 percent versus 16 percent for rest pain) (p < 0.01). Aortofemoral bypass for impending limb loss yields satisfactory long-term results, and the extent of tissue loss preoperatively is an important prognostic factor. Prognosis for survival and limb salvage is worse and the need for additional distal reconstruction greater in patients with ischemic ulcer or gangrene.

Adult↗
PubMed1981

Motor speech malfunction following carotid endarterectomy.

Cranial nerve injury during carotid endarterectomy is a well-recognized complication of this procedure. The evaluation of the extent of the injury and the persistence of the malfunction is difficult to accomplish with conventional methods. A protocol designed to evaluate motor speech function was administered to 36 patients prior to carotid endarterectomy, 2 days after surgery, and 6 weeks postoperatively. The protocol included assessments of hypoglossal nerve function, superior-recurrent laryngeal function, glossopharyngeal nerve function, and integrated motor speech ability. Direct laryngoscopy also was performed at the same time intervals. The total number of operations was 40. Hypoglossal nerve palsy was present in eight (20%) and superior-recurrent laryngeal nerve palsy was found in 11 (27.5%). Seven (17.5%) had malfunction of the vocal cords by the second postoperative day. Only seven (17.5%) of the above cases were detected by the spontaneous speech sample. The malfunction persisted by the sixth postoperative week in one patient (2.5%) with hypoglossal palsy and in two (5%) with superior-recurrent laryngeal palsy (one of them with ipsilateral vocal cord paralysis). We think that motor speech-related difficulties are far more common following carotid endarterectomy than is generally believed, and although these difficulties are, by far, temporary in course, they deserve attention, especially in cases of planned bilateral carotid endarterectomy.

Carotid Arteries↗
PubMedDate not supplied

Carotid body paraganglioma and SDHD mutation in a Greek family.

BACKGROUND: Carotid body (CB) is a highly specialized paraganglion originating from the neural crest ectoderm. CB paraganglion can be caused either by a genetic predisposition (hereditary paraganglia) or by chronic hypoxic stimulation. Germline mutations in any of the following genes: SDHD, SDHC, SDHB, PGL2 or other unknown genes, can cause paragangliomas (PGLs). MATERIALS AND METHODS: We studied a Greek family in which the two daughters had carotid body paraganglioma, whereas both parents did not. RNA extraction, reverse transcriptase polymerase chain reaction and direct DNA sequencing were performed, in order to identify SDHD mutations in all four exons. RESULTS: Our results revealed the existence of the missense mutation Y114C, in exon-4 of the SDHD gene, in the unaffected father and both affected sisters. CONCLUSION: DNA testing was performed, for the first time in Greece, on patients with carotid body tumor. This marks a new geographical location, in the literature, for this mutation.

Adult↗
PubMedDate not supplied

Vascular manifestations of Behçet's disease.

The purpose of this article is to present the spectrum of vascular disease accompanying Behçet's disease. Four cases of the disease with various vascular manifestations are presented. In the first case superior vena cava syndrome due to thrombosis was the presenting symptom. In the second case foot ischemia with toe necrosis was prevalent. In the third case the patient developed recurrent aneurysmal disease in large and medium size arteries requiring successive vascular surgery, and in the fourth case the patient had SVC thrombosis and ruptured femoral aneurysm. All four patients were young males. Although vascular complications of Behçet disease are uncommon they may pose serious therapeutic problems.

Adult↗