Giuseppe Panuccio

University Medical Center Hamburg-Eppendorf

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Tilo Kölbel

Universität Hamburg

117

Fiona Rohlffs

Universität Hamburg

Nikolaos Tsilimparis

Ludwig-Maximilians-Universität München

Ahmed Eleshra

Mansoura University

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Κωνσταντίνος Σπανός

University Medical Center Hamburg-Eppendorf

Petroula Nana

University Medical Center Hamburg-Eppendorf

José I. Torrealba

University Medical Center Hamburg-Eppendorf

Franziska Heidemann

Asklepios Fachklinikum Brandenburg

Giovanni Torsello

University of Göttingen

Martin Austermann

St. Franziskus Hospital

Cooperative Institutions

University Medical Center Hamburg-Eppendorf

Universität Hamburg

Society of Interventional Radiology

American College

Magna Graecia University

Istituti di Ricovero e Cura a Carattere Scientifico

Codarts Rotterdam

Bucheon University

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Society for Vascular Surgery

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542 Ceftriaxone-induced Kounis syndrome in the time of COVID-19

European Heart Journal Supplements (2021)

Giuseppe Panuccio Iolanda Aquila Giuseppe Neri Claudia Chiarello Annalisa Mongiardo

Abstract A 53 years old male subject with diabetes mellitus, hypertension, dyslipidaemia, obesity, and history of perianal abscess was admitted to the local hospital for generalized maculopapular rash on his trunk and limbs, which was accompanied by intense itching, sweating, hypotension, and severe chest pain. The rash and the accompanying signs/symptoms appeared 10 min after the administration of ceftriaxone (2 g) as antibiotic therapy for the perianal abscess. The patient had no clinical history for any type of allergy. At the first medical contact, an urgent electrocardiogram was taken showing ST-segment elevation in the anterior–lateral leads. The patient was still then treated with methylprednisolone and adrenalin i.v. as an anaphylactic shock was suspected. Afterwards, the patient was admitted in the emergency department, where he showed flu-like symptoms, chills, and fever. An echo-fast showed left ventricular wall motion abnormalities with hypokinesia of the anterior and posterior wall and moderate mitral regurgitation with normal EF. Laboratory tests showed increased levels of high-sensitivity cTnT (32.8 ng/l; NV < 14), white blood cells (13.74 × 103/μl; NV 5.2–12.4 × 103), IL-6 (10.54 pg/ml; NV < 7), C-reactive protein (PCR) (29.3 mg/l; NV 0–3). As for the cutaneous manifestations, flu-like symptoms, and blood test results (elevation of IL-6 and PCR despite an increase of white cell count) a SARS COV-2 swab was done. As recently noted in several preliminary studies, COVID-19 patients indeed show erythematous rash, and localized or widespread urticaria as initial manifestations in acute severe cases along with the humoural acute-phase response. The latter made it complicated to distinguish viral infection vs. drug administration as the underlying cause of the event. In the meantime, the patient started the treatment for an acute coronary syndrome and acetylsalicylic acid 100 mg, clopidogrel 300 mg orally, and enoxaparin dose subcutaneously were administered. Chest pain disappeared 30 min later and the ECG returned to normal 40 min after drug administration. Subsequently, the swab test result turned to be negative for SARS-CoV-2 and the patient was transferred to our centre for an emergency coronary angiography that revealed proximal subocclusive thrombotic stenosis and middle 70–80% thrombotic stenosis of the left anterior descending (LAD) coronary artery and a 80% thrombotic stenosis of the distal portion of the circumflex. Both vessels’ respective stenoses were treated with PCIs. When considering all together the anamnestic, laboratory, and instrumental/invasive findings, a case of Kounis Syndrome (KS) was suspected. Kounis syndrome (KS) has been indeed defined as cardiovascular symptoms that occur secondary to allergic or hypersensitivity insults mainly elicited by specific medications in male patients. KS involves the following three recognized variants: Type 1: the acute coronary event is secondary to spasm; Type 2: coronary thrombosis is the main culprit, and Type 3: the coronary event occurs secondary to drug-eluting stent thrombosis. Therefore, the patient was finally discharged with the diagnosis of ST-elevated MI likely secondary to a type II KS.

Chills

Maculopapular rash

White blood cell

10.1093/eurheartj/suab140.037

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Citations (1)

Outcomes of Directional Branches of the T-Branch Off-the-Shelf Multi-Branched Stent-Graft

Journal of Clinical Medicine (2022)

Κωνσταντίνος Σπανός Tomasz Jakimowicz Petroula Nana Christian‐Alexander Behrendt Giuseppe Panuccio

Background: A controversy on bridging covered stent (BCS) choice, between self-expanding (SECS) and balloon-expandable (BECS) stents, still exists in branched endovascular repair. This study aimed to determine the primary target vessel (TV) patency in patients treated with the t-Branch device and identify factors impairing the outcomes. Methods: A retrospective study was undertaken, including patients treated with the t-Branch (Cook Medical, Bloomington, IN, USA) between 2014 and 2019 (early 2014–2016; late 2017–2019). The endpoint was the primary patency (CT: celiac trunk, SMA, superior mesenteric artery, RRA: right renal artery, LRA: left renal artery) during the follow-up. Any branch instability event was assessed. The factors affecting the patency were determined using multivariable regression models and Kaplan–Meier analyses. Results: In total, 2018 TVs were analyzed; 1542 SECSs and 476 BECSs. The CT patency was 99.8% (SE 0.2%) at the 1st month, with no other event. The SMA patency was 97.8% (SE 1) at the 12th month. The RRA patency was 96.7% (SE 2) at the 24th month. The LRA patency was 99% (SE 0.4) at the 6th month. Relining was the only factor independently associated with the SMA patency (OR 8.27; 95% CI 1.4–4.9; p = 0.02). The freedom from instability was 62% (SE 4.3%) and 45% (SE 5.4%) at the 24th month and 36th month. No significant difference was identified between the BECSs and SECSs in the early or late experience. Conclusion: BCS for the t-Branch branches performed with a good primary patency during the short-term follow-up. The type of BCS did not influence the patency. Relining might be protective for SMA patency.

Off the shelf

10.3390/jcm11216513

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Forthcoming Articles

Journal of Vascular and Interventional Radiology (2023)

Matthias Stechele Moritz Wildgruber Aurelia Markezana Sophia K€ Astle Elif Öcal

10.1016/s1051-0443(23)00306-8

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List of Contributors

Elsevier eBooks (2018)

Konstantinos P. Donas Giovanni Torsello Kenneth Ouriel Martin Austermann Efthymios Beropoulis

10.1016/b978-0-323-51148-3.01002-5

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Internal Iliac Artery Stenting During and After Endovascular Aortic Repair for Prevention and Therapy of Spinal Cord Ischemia

European Journal of Vascular and Endovascular Surgery (2019)

Catharina Gronert Giuseppe Panuccio Fiona Rohlffs Nikolaos Tsilimparis Sebastian Debus

Collateral circulation

Paraplegia

Internal iliac artery

10.1016/j.ejvs.2019.09.218

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Effectiveness of Endovascular Navigation With Fiber Optic RealShape Technology: A Single-Center Prospective Study of the First 50 Patients

Journal of Vascular Surgery (2022)

Giuseppe Panuccio Tilo Kölbel Fiona Rohlffs Franziska Heidemann

10.1016/j.jvs.2022.03.484

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Durability of a low-profile stent graft for thoracic endovascular aneurysm repair

Journal of Vascular Surgery (2017)

Giovanni Torsello Mirjam Inchingolo Martin Austermann Giovanni Torsello Giuseppe Panuccio

Endovascular aneurysm repair

Thoracic aortic aneurysm

10.1016/j.jvs.2017.04.042

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In Perugia 40% of necks enlarge and cause problems

G Parlani Paola De Rango L Romano Giorgio Lo Iacono Giuseppe Panuccio

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Branched Endovascular Aortic Repair After a Migrated EVAR Bypassing a Severely Kinked Previous Endograft

Journal of Endovascular Therapy (2022)

José I. Torrealba Tilo Kölbel Fiona Rohlffs Κωνσταντίνος Σπανός Giuseppe Panuccio

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.

Endovascular aneurysm repair

Cuff

Aortic repair

Abdominal aorta

Internal iliac artery

10.1177/15266028221134888

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Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms

Journal of Vascular Surgery (2015)

Theodosios Bisdas Giuseppe Panuccio Masayuki Sugimoto Giovanni Torsello Martin Austermann

Aortic repair

10.1016/j.jvs.2015.01.044

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Citations (169)