Lazaros Reppas

Attikon University Hospital · Department of Radiology II

Image-guided percutaneous cholecystostomy (IGPC) is a widely recognized and regularly employed procedure in numerous institutions, serving as an indispensable cornerstone in the management of patients with acute cholecystitis. The most up-to-date literature has found that the transperitoneal route is at least as safe as the transhepatic route and t...

TACE can be performed via common femoral or radial artery access, although brachial artery or distal transradial access can be also used [1–3]. A transradial access offers the benefit of immediate mobilization/ambulation with minimal bleeding complications and less patient discomfort, and is advised in obese patients with hostile abdomen, those una...

See Figs. 16.1, 16.2, 16.3, 16.4, 16.5, 16.6, 16.7, 16.8 and 16.9

Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-...

Purpose: To investigate whether Doppler ultrasound (DUS) blood flow parameters could serve as quantifiable functional endpoints of peripheral endovascular arterial procedures for chronic limb-threatening ischemia (CLTI), influencing wound healing. Methods: This is a prospective single-center study investigating intraprocedural DUS parameters (pu...

Objectives The purpose of this study is to investigate the safety and effectiveness of the US-guided bedside trocar vs. the Seldinger technique for percutaneous cholecystostomy (PC) procedures. Methods This is a prospective single-center, randomized, controlled trial (RCT) comparing the trocar (group T; 50 patients [27 men]; mean [± SD] age, 74.16...

Introduction: Liver-dominant metastatic colorectal cancer is noted in approximately 20%-35% of the patients. Systemic chemotherapy remains the first-line treatment for mCRC, but the prognosis is poor due to liver failure. Novel minimally invasive technologies have enabled the optimization of locoregional treatment options. Areas covered: This is...

Pancreatic cancer is currently the seventh leading cause of cancer death (4.5% of all cancer deaths) while 80%-90% of the patients suffer from unresectable disease at the time of diagnosis. Prognosis remains poor, with a mean survival up to 15 mo following systemic chemotherapy. Loco-regional thermal ablative techniques are rarely implemented due t...

Purpose: To evaluate in vivo the feasibility, safety, and paclitaxel (PTX) deliverability of a newly developed non-commercially available Paclitaxel-Coated Balloon (PCB) catheter in the swine healthy peripheral vein model. Materials and methods: In total 12 PCBs were deployed in 12 venous segments. Primary feasibility endpoint was the successful...

Background: Direct percutaneous embolization, has been deliberately employed before on various occasions. However, to our knowledge, there is no report in the literature, of its use in order to achieve urgent hemostasis after iatrogenic erroneous arterial puncture. Case presentation: A 75-year-old female patient underwent a CT-guided biopsy of a pa...

Inflammatory diseases of the pancreas or pancreatic trauma result in ductal cell disruption, which in turn may lead to leakage of pancreatic fluid, mostly in the retroperitoneal space. Pancreatopleural fistulas are uncommonly encountered following pancreatic injury; however, they often prove a difficult problem to manage. Herein, we present a rare...

Purpose: To assess the feasibility of multi-detector computed tomography angiography (MDCTA) volumetry for the quantification and grading of acute non-cerebral, non-gastrointestinal bleeding. Methods: This retrospective, single-center study investigated consecutive patients with MDCTA positive for active non-cerebral, non-gastrointestinal bleedi...

Objectives To investigate the feasibility of VF-assisted angioplasty (VFA) in dysfunctional AVF using sequential intraprocedural duplex ultrasound (DUS), to utilize intraprocedural VF as a quantifiable, functional endpoint in endovascular treatment.Methods This prospective study included 20 consecutive patients (23 lesions; 16 men; mean age 67 ± 16...

The CIRSE Standards of Practice Committee established a writing group that was tasked with producing up-to-date recommendations for performing below-the-knee revascularisation, taking into account data on novel techniques, devices, and long-term outcomes that have emerged over the last decade. CIRSE Standards of Practice documents are not clinical...

Objectives To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. Methods Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean pati...

Objectives To assess the feasibility of Multi-Detector Computed Tomography Angiography (MDCTA) volumetry for the quantification and grading of acute non-cerebral, non-gastrointestinal bleeding. Methods This retrospective, single-center, study investigated consecutive patients with MDCTA positive for active non-cerebral, non-gastrointestinal bleedin...

Purpose To assess safety and efficacy of CT-guided radio frequency ablation (RFA) and Magnetic Resonance guided Focused Ultrasounds (MRgFUS) in the treatment of osteoid osteoma with a long-term follow-up study (mean follow-up time longer than 2 years). Materials and Methods Database research was carried out in two different centres with experience...

Background We retrospectively investigated outcomes of emergency TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding diathesis. Materials and methods This multicenter, retrospective, study, was designed to investigate the safety and efficacy of percutaneous TAE for the management of life-threatening haemorr...

Purpose To evaluate the feasibility, safety and long-term efficacy of super-selective trans-catheter arterial embolization for the management of intractable bladder bleeding. Materials and methods The records of 20 patients with intractable haematuria referred urgently for selective arterial embolization after failed conventional therapy, between...

Background The complexity of the case, including the rarefied simultaneous occurrence of complications—iatrogenic, as well as reperfusion injury, invite reporting and publication. Case presentation A 39-year-old woman with a single-functioning left kidney, previous left renal artery stenting (RAS), and known hypercoagulopathy was hospitalized for...

Purpose To investigate our centre’s experience on CT‐guided, transforaminal, intrathecal administration of Nusinersen in adult subjects with SMA type 2 and severe spinal deformity. Materials and Methods This is a retrospective, single‐center, study investigating the feasibility and safety of CT‐guided, transforaminal, lumbar puncture for the intra...

OBJECTIVE. The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS. This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the tro...

Purpose: To investigate the bleeding complications associated with endovascular therapy (EVT) for peripheral artery disease (PAD) and develop a dedicated peripheral bleeding score (PBS). Materials and Methods: This prospective, single-center study enrolled 530 patients (mean age 67.6±9.8 years; 396 men) undergoing endovascular procedures between Au...

Purpose of review: To present the latest evidence about carotid artery stenting (CAS) including indications, safety, efficacy, and available equipment. Recent findings: The micromesh stent, a new stent design which offers excellent flexibility and embolic protection, has been associated with promising outcomes. Summary: CAS has emerged as a mi...

Introduction: Percutaneous transluminal angioplasty (PTA) currently remains the endovascular treatment of choice in a large percentage of patients suffering from peripheral artery disease (PAD). However, the mechanism of angioplasty itself can cause some extent of arterial dissection leading to early vessel restenosis/reocclusion. Current endovascu...

Over 20 million adults in Europe suffer from peripheral arterial disease (PAD). The annual incidence of PAD is approximately 2.4%, while the annual incidence of critical limb ischaemia (CLI), the last and most severe stage of PAD, has been reported to be 0.4%. Endovascular angioplasty and/or stenting of infrapopliteal disease is, today, an establis...

Introduction Ischemic stroke is becoming a primary cause of disability and death worldwide. To date, therapeutic options remain limited focusing on mechanical thrombolysis or administration of thrombolytic agents. However, these therapies do not promote neuroprotection and neuro-restoration of the ischemic area of the brain. Areas Covered This revi...

Objectives To investigate the incidence and endovascular treatment of severe spontaneous non-cerebral hemorrhage (SSNCH) in a high-volume, tertiary university hospital. Methods All patients diagnosed with SSNCH between January 2016 and June 2017 were retrospectively analyzed. Endovascular treatment (group EVT) was offered only in patients demonstr...

Purpose: To investigate the safety and efficacy of percutaneous stenting for the management of chronic ischemia caused by endograft limb occlusion following endovascular aneurysm repair (EVAR). Materials and methods: This is a retrospective, single-centre study investigating all patients who underwent percutaneous endovascular covered or bare me...

Purpose: To report the incidence and long-term outcomes following endovascular treatment of symptomatic, atherosclerotic isolated popliteal artery disease (IPAD). Materials and methods: This retrospective, multicenter study included all patients who underwent endovascular treatment of IPAD between January 2010 and December 2016 because of interm...

Purpose: To compare post-therapeutic pain and analgesia following surgical hepatectomy versus image - guided percutaneous microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC). Material and Methods: This is a retrospective, single-cener, study of 64 consecutive patients with HCC,who underwent either partial hepatectomy (Grou...

To compare post-therapeutic pain and analgesia following surgical hepatectomy versus image-guided percutaneous microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC)

PurposeTo investigate the outcomes of transcatheter arterial embolization (TAE) for the treatment of peptic ulcer bleeding (PUB). Materials and Methods This is a retrospective, multicenter study, which investigated all patients who underwent TAE for the treatment of severe upper gastrointestinal hemorrhage from peptic ulcers in five European center...

Chondrosarcoma is a rare malignancy characterized by the production of cartilage matrix, displaying heterogeneous histopathology and clinical behavior. Due to lack of effective treatment for advanced disease, the clinical management of metastatic chondrosarcoma is exceptionally challenging. Chondrosarcomas harbor molecular abnormalities, such as ov...

Purpose: To report the safety and efficacy of occluded transjugular intrahepatic portosystemic shunts (TIPS) recanalization using the stiffening cannula (SC) technique. Materials and methods: This is a retrospective, single-centre, single-arm study, investigating the safety and efficacy of transjugular recanalization of occluded TIPS using the S...

Objectives: To evaluate the clinical efficacy/safety of CT-guided percutaneous microwave ablation for HCC in challenging locations using high-power microwave platforms. Materials and methods: A retrospective review was conducted in 26 patients with 36 HCC tumorss in challenging locations (hepatic dome, subcapsular, close to the heart/diaphragm/h...

Background: Pharmacotherapy is of increasing interest in peripheral arterial disease (PAD), with novel therapies aiming at different factors contributing to the disease. For antiplatelet therapy, there is no unanimous agreement regarding the nature or duration of optimal antiplatelet therapy so as to reduce major adverse cardiovascular and limb-re...

Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy...

Aims: Diagnosis of vascular involvement in diabetic foot ulceration (DFU) remains challenging. We conducted a proof of concept study to investigate the feasibility of microwave radiometry (MWR) thermometry for non-invasive differential diagnosis of critical limb ischemia (CLI) in subjects with DFU. Methods: This prospective, multi-center, study...

Purpose: To investigate long-term efficacy of transjugular intrahepatic porto-systemic shunt (TIPS) creation for the management of symptomatic Budd Chiari Syndrome (BCS) refractory to drug therapy. Material and methods: This is a retrospective, single-centre analysis of 27 consecutive patients (17 female and 10 male patients; mean age: 50.8 ± 15.0...

Massive Hemoptysis and pulmonary embolism are two very severe and potentially fatal pulmonary emergencies requiring completely different treatments. We present the case of a 45-year old male transmitted to our Hospital for massive hemoptysis who at the same time was found to suffer from pulmonary embolism. Hemoptysis was treated with bronchial arte...

Introduction: Critical limb ischemia (CLI) constitutes a life-limiting and life-threatening disease. Revascularization, either endovascular or surgical, remains the best treatment option accompanied by medication and risk factor modification. Patients unable to undergo revascularization, referred as “no-option patients”, have been the center of int...

A patient with non-alcoholic fatty liver disease (NAFLD) and unresectable small-sized (≤3 cm) diffuse liver metastases from adenocarcinoma of the rectosigmoid junction was assessed for treatment with transarterial radioembolization (SIRT). The right hepatic arteriogram demonstrated several hypervascular lesions. However, the planar and the SPECT im...

Purpose To report our experience with the use of a battery-powered drill in biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation. The battery-powered drill enables obtaining the sample while drilling. Materials and Methods During the last 18 months, 14 patients suffering from painful osteoid osteoma with exc...