R. Spear
university of lille
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Publication
Featured researches published by R. Spear.
European Journal of Vascular and Endovascular Surgery | 2016
R. Spear; Jonathan Sobocinski; Nicla Settembre; Mark Tyrrell; S. Malikov; B. Maurel; Stéphan Haulon
OBJECTIVES Outcomes are reported in management of post-dissection aneurysms involving the aortic arch and/or thoraco-abdominal segment (TAAA) treated with fenestrated and branched (complex) endografts. METHODS This report includes all patients with chronic post-dissection aneurysms >55 mm in diameter, deemed unfit for open surgery, treated using complex endografts between October 2011 and March 2015. When appropriate, staged management strategies including left subclavian artery revascularization, thoracic endografting, dissection flap fenestration or tear enlargement, and other endovascular procedures were performed at least 3 weeks prior to definitive complex endovascular repair. The following outcome data were collected prospectively at discharge, 12 months and annually thereafter: technical success, endoleaks, target vessel patency, false lumen patency, aneurysm diameter, major and minor complications, re-interventions, and mortality. RESULTS The cohort comprised 23 patients with a median age of 65 years. Staged procedures were performed in 14 patients (61%). Seven patients with dissections involving the arch were treated with inner branched endografts, and 16 TAAA patients were treated with fenestrated or branched endografts. The technical success rate was 71% following arch repair and 100% following TAAA repair. During early follow up, one of the arch group patients died and one in the TAAA group suffered spinal cord ischemia. The median follow up was 12 months (range 3-48), during which time one patient died of causes unrelated to aneurysm or treatment. Two early re-interventions were performed in the arch group to correct access vessel complications and there were a further two late re-interventions in the TAAA group to treat endoleaks. All target vessels (n = 72) remained patent. CONCLUSIONS This experience indicates that complex endovascular repair of post-dissection aneurysms is a viable alternative to open repair in patients deemed unfit for open surgery. There are insufficient data to allow comparison with the outcome of open surgery in anatomically similar, but fit, patients.
European Journal of Vascular and Endovascular Surgery | 2015
Adrien Hertault; B. Maurel; F. Pontana; T. Martin-Gonzalez; R. Spear; Jonathan Sobocinski; I. Sediri; C. Gautier; Richard Azzaoui; M. Rémy-Jardin; Stéphan Haulon
OBJECTIVES This study evaluated a new strategy to assess technical success after standard and complex endovascular aortic repair (EVAR), combining completion contrast enhanced cone beam computed tomography (ceCBCT) and post-operative contrast enhanced ultrasound (CEUS). METHODS Patients treated with bifurcated or fenestrated and branched endografts in the hybrid room during the study period were included. From December 2012 to July 2013, a completion angiogram (CA) was performed at the end of the procedure, and computed tomography angiography (CTA) before discharge (group 1). From October 2013 to April 2014, a completion ceCBCT was performed, followed by CEUS during the 30 day post-operative period (group 2). The rate of peri-operative events (type I or III endoleaks, kinks, occlusion of target vessels), need for additional procedures or early secondary procedures, total radiation exposure (mSv), and total volume of contrast medium injected were compared. RESULTS Seventy-nine patients were included in group 1 and 54 in group 2. Peri-operative event rates were respectively 8.9% (n = 7) and 33.3% (n = 18) (p = .001). Additional procedures were performed in seven patients (8.9%) in group 1 versus 17 (31.5%) in group 2 (p = .001). Two early secondary procedures were performed in group 2 (3.7%), and three (3.8%) in group 1 (p = .978). Median radiation exposure due to CBCT was 7 Gy cm(2) (5.25-8) (36%, 27%, and 9% of the total procedure exposure, respectively for bifurcated, fenestrated, and branched endografts). CEUS did not diagnose endoleaks or any adverse events not diagnosed by ceCBCT. Overall radiation and volume of contrast injected during the patient hospital stay in groups 1 and 2 were 34 (25.8-47.3) and 11 (5-20.5) mSv, and 184 (150-240) and 91 (70-132.8) mL respectively (reduction of 68% and 50%, p < .001). CONCLUSIONS Completion ceCBCT is achievable in routine practice to assess technical success after EVAR. Strategies to evaluate technical success combining ceCBCT and CEUS can reduce total in hospital radiation exposure and contrast medium volume injection.
European Journal of Vascular and Endovascular Surgery | 2014
R. Spear; Richard Azzaoui; B. Maurel; Jonathan Sobocinski; Blayne A. Roeder; S. Haulon
INTRODUCTION Endovascular repair of aortic arch aneurysms using an inner-branched device is a new treatment option for patients unfit for open surgery. There are many anatomical restrictions, such as the presence of a mechanical aortic valve that can contraindicate this complete endovascular approach. REPORT A new delivery system to overcome this issue has been developed. This new system was used to treat an aortic arch aneurysm 77 mm in diameter in a 37-year-old patient with Marfans syndrome. The patient was considered to be at major risk for open surgery because of severe respiratory insufficiency following a second sternotomy. DISCUSSION Total endovascular arch aneurysm repair is no longer contraindicated in patients with a mechanical aortic valve.
European Journal of Vascular and Endovascular Surgery | 2013
Adrien Kaladji; R. Spear; Adrien Hertault; Jonathan Sobocinski; B. Maurel; Stéphan Haulon
BACKGROUND To assess the accuracy of the aortic outer curvature length for thoracic endograft planning. METHODS Seventy-four patients (58 men, 66.4 ± 14 years) who underwent thoracic endovascular aortic repair between 2009 and 2011 treated with a Cook Medical endograft were enrolled in this retrospective study. Immediate postoperative CT scans were analysed using EndoSize software. Three vessel lengths were computed between two fixed landmarks placed at each end of the endograft: the straightline (axial) length, the centerline length and the outer curvature length. A tortuosity index was defined as the ratio of the centerline length/straightline length. A Student t test and a Pearson correlation coefficient were used to examine the results. RESULTS We found a significant difference between the centerline length (135.4 ± 24 mm) and that of the endograft (160 ± 29 mm) (p < .0001). This difference correlates with the tortuosity index (r = .818, p < .0001), the endograft length (r = .587, p < .0001), and the diameter of the endograft (r = .53, p < .0001). However, the outer curvature length (161.3 ± 29 mm) and the endograft length (160 ± 29 mm) were similar (p = .792). CONCLUSION The outer curvature length more accurately reflects that of the deployed endograft and may prove more accurate than centerlines in planning thoracic endografts.
British Journal of Surgery | 2018
Rachel E. Clough; R. Spear; K. Van Calster; Adrien Hertault; Richard Azzaoui; Jonathan Sobocinski; D. Fabre; Stéphan Haulon
Surgical repair of aortic arch pathology is complex and associated with significant morbidity and mortality. Alternative approaches have been developed to reduce these risks, including the use of thoracic stent‐grafts with fenestrations or in combination with bypass procedures to maintain supra‐aortic trunk blood flow. Branched stent‐grafts are a novel approach to treat aortic arch pathology.
Journal of Vascular Surgery | 2017
Katrien Van Calster; Aurélia Bianchini; R. Spear; Adrien Hertault; Matthieu Delloye; Richard Azzaoui; Jonathan Sobocinski; Stéphan Haulon
an overall in-hospital mortality of 7.2% (7 of 97). Follow-up data were obtained from all patients, and the mean follow-up time was 43.36 25.5 months. The 5-year survival rate by Kaplan-Meier analysis was 86. 6%. Three patients with type I endoleak was successfully resolved during the operation. No endograft caudal migration occurred. Late aortic rupture was found in two patients, and two patients received reoperations during the follow-up period. No postoperative paraplegia was found. Conclusions: The long-term outcomes of hybrid total arch repair for dissecting aneurysms are satisfactory. This procedure may be an alternative for conventional total arch replacement for high-risk patients.
European Journal of Vascular and Endovascular Surgery | 2012
R. Spear; B. Maurel; Jonathan Sobocinski; Paolo Perini; Matthieu Guillou; Marco Midulla; Richard Azzaoui; G. Tefera; Stéphan Haulon
Journal of Cardiovascular Surgery | 2014
Jonathan Sobocinski; R. Spear; Mark Tyrrell; B. Maurel; Martin Gonzalez T; Adrien Hertault; Marco Midulla; Richard Azzaoui; S. Haulon
Journal of Cardiovascular Surgery | 2016
B. Maurel; Mastracci Tm; R. Spear; Adrien Hertault; Richard Azzaoui; Jonathan Sobocinski; Stéphan Haulon
Journal of Cardiovascular Surgery | 2016
Jonathan Sobocinski; Patterson Bo; Rachel E. Clough; R. Spear; Martin-Gonzalez T; Richard Azzaoui; Adrien Hertault; Stéphan Haulon