Publications by authors named "S Zerwes"

18 Publications

Open Conversion After Endovascular Aneurysm Sealing: Technical Features and Clinical Outcomes in 44 Patients.

J Endovasc Ther 2021 Apr 25;28(2):332-341. Epub 2020 Nov 25.

Clinic for Vascular and Endovascular Surgery, Medizinische Fakultät, Universität Augsburg, Germany.

Purpose: To evaluate the technical features and clinical results after open conversion for complications following endovascular aneurysm sealing (EVAS).

Materials And Methods: From July 2013 to February 2020, 44 patients (mean age 72±8 years; 36 men) underwent an open conversion due to EVAS complications in a single center. Data were collected on patient characteristics, reasons for conversion, characteristics and duration of the procedure, condition of the polymer, blood loss, time in the intensive care unit (ICU), and intra/postoperative complications. The main outcome measure was mortality at 30 days and in follow-up. Data are presented as the median (IQR) and absolute range.

Results: On average, the open conversion took place 3 years after the initial EVAS implantation [median 37 months (IQR 23, 50); range 0-64]. Most patients were converted due migration (82%), aneurysm growth (77%), and/or endoleak (75%), with 21 patients (48%) having all 3 events. Less frequent diagnoses were aneurysm rupture (n=7), aortic infection (n=3), technical failure during implantation (n=2), and graft thrombosis (n=1). The majority of patients (n=26) were asymptomatic and converted electively, but 9 were operated on urgently and 9 emergently (7 late rupture and 2 due to technical failure). The median procedure duration was 178 minutes (IQR 149, 223; range 87-417), the median blood loss was 1100 mL (IQR 600, 2600; range 300-5000). Polymer degradation was mentioned in the operative reports of 18 cases (41%). Patients stayed a median of 3 days (IQR 2, 7; range 1-35) in the ICU, while the median length of stay in the hospital was 14 days (IQR 10, 20; range 0-93). The 30-day mortality was 23% (n=10). During a median follow-up of 3 months (IQR 0, 11; range 0-38), no additional deaths occurred, but 12 patients suffered from an adverse event. There were 3 cases of wound dehiscence after laparotomy, 2 cases of leg ischemia, 2 cases of renal failure, and individual cases of urinary obstruction, urinoma, paralytic ileus, gastrointestinal bleeding, and postoperative delirium. A non-elective setting was associated with a significantly increased mortality of 33% in urgent cases and 56% in emergent cases (p=0.007). Based on these results an algorithm for the management of EVAS complications was developed.

Conclusion: The significantly increased mortality associated with nonelective conversions highlights the need for active surveillance. The presented algorithm offers a structured tool to avoid emergency conversions.
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http://dx.doi.org/10.1177/1526602820971830DOI Listing
April 2021

[COVID-19 infection-Risk of thromboembolic complications].

Gefasschirurgie 2020 Sep 1:1-6. Epub 2020 Sep 1.

Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156 Augsburg, Deutschland.

While the COVID-19 syndrome triggered by the SARS CoV‑2 was initially seen predominantly as a pulmonary disease, the number of reports of vascular complications has recently increased. The aim of the present review article is to summarize the most relevant vascular complications in COVID-19 patients. These include venous and arterial thromboembolic events as well as local thromboses, which can form directly on the endothelium at the site of cytokine release. A generalized coagulopathy also appears to promote this thrombogenic condition. With a rate of approximately 20%, deep vein thrombosis (DVT) of the leg is one of the most common thromboembolic events in COVID-19 patients requiring intensive care treatment. In addition, arterial events, such as stroke or acute coronary syndrome were also observed in COVID-19 patients with pre-existing vascular disease. Children rarely have vascular complications, but a systemic immune response similar to the Kawasaki syndrome and toxic shock syndrome has been reported. According to current data, the risk of thromboembolic events in hospitalized COVID-19 patients is significantly increased, making thrombosis prophylaxis with low molecular weight or unfractionated heparin necessary. If pharmaceutical thrombosis prophylaxis is contraindicated, intermittent pneumatic compression should be used. In addition, in patients admitted to the hospital with suspected or proven SARS-CoV‑2 infection, the determination of D‑dimers and, in the case of positive results, broad indication for compression sonography of the deep leg veins are recommended. This allows to detect and treat DVT at an early stage. The treatment of thromboses should be carried out according to current guidelines with therapeutic anticoagulation. Further studies and registries are needed to improve the understanding of the relationship between COVID-19 infection and the occurrence of thromboembolic events.
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http://dx.doi.org/10.1007/s00772-020-00687-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462439PMC
September 2020

[Erratum to: Increased risk of deep vein thrombosis in intensive care unit patients with CoViD-19 infections?-Preliminary data].

Chirurg 2020 07;91(7):586-587

Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.

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http://dx.doi.org/10.1007/s00104-020-01245-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322217PMC
July 2020

[Resuscitative endovascular balloon occlusion of the aorta (REBOA) : Current aspects of material, indications and limits: an overview].

Chirurg 2020 Nov;91(11):934-942

Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) describes an endovascular procedure in which a blocking balloon is introduced into the aorta to reduce bleeding situated distal to the balloon and simultaneously to improve cardiac and cerebral oxygenation.

Objective: Presentation of the REBOA technique, the possible indications, the required material and possible complications of the procedure.

Material And Methods: Non-systematic review of the currently available literature.

Results: The REBOA procedure is an adjunct to achieve hemodynamic stabilization in patients with traumatic hemorrhage and ruptured aortic aneurysms. The complication rate of the procedure is approximately 5%, whereby access complications are the most common; however, fatal complications are also possible.

Conclusion: A balloon block of the aorta is well established in the treatment of ruptured aortic aneurysms. There is growing evidence that REBOA is a minimally invasive alternative to open surgical cross-clamping of the aorta by thoracotomy for the treatment of patients with polytrauma and hemorrhagic shock due to abdominal or visceral bleeding. Due to the development of new balloon catheters, which can be placed without stiff guidewires and require smaller sheath diameters, REBOA is also discussed for treatment of postoperative abdominal or gynecological bleeding or as a possible adjunct to cardiopulmonary resuscitation for nontraumatic cardiac arrest.
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http://dx.doi.org/10.1007/s00104-020-01180-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581582PMC
November 2020

[Increased risk of deep vein thrombosis in intensive care unit patients with CoViD-19 infections?-Preliminary data].

Chirurg 2020 Jul;91(7):588-594

Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.

Background: The incidence of deep vein thrombosis (DVT) in CoViD-19 patients in intensive care units (ICU) has so far been investigated in only a few studies. Prospective comparative studies with non-CoViD-19 ICU patients are completely lacking.

Objective: Evaluation of the incidence of DVT in ICU patients with CoViD-19 compared to non-CoViD-19 ICU patients who were treated in the University Hospital Augsburg during the same period. In addition, the aim was to investigate what type of anticoagulation was present in CoViD-19 patients at the time the DVT occurred and to what extent DVT is associated with increased mortality in this patient population.

Material And Methods: In this prospective single center study, which was conducted between 18 April 2020 and 30 April 2020, 20 SARS-CoV2 positive patients were compared with 20 non-CoVid-19 patients in the ICU with respect to the occurrence of DVT. For this purpose, demographic data, laboratory parameters, and clinical outcomes were recorded and evaluated.

Results: The rate of DVT in the investigated patient collective was markedly higher in patients with SARS-CoV2 (CoViD-19 patients 20% vs. non-CoViD-19 patients 5%). Both DVT and elevated D‑dimer levels were associated with increased mortality in the present study.

Conclusion: We recommend the determination of D‑dimer levels and, in the case of elevated levels, the broad indication for compression sonography of the deep leg veins on admission of patients with suspected or confirmed SARS-CoV2. In this way DVT in the setting of CoViD-19 can be recognized early and therapeutic anticoagulation can be started. All inpatient CoViD-19 patients should receive thrombosis prophylaxis with low molecular weight heparin. Further studies on point of care methods (TEG®, ROTEM®) for the detection of hypercoagulability in SARS-CoV2 are necessary.
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http://dx.doi.org/10.1007/s00104-020-01222-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274071PMC
July 2020
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