University Hospital for Vascular Surgery

3616

acute lower limb ischemia, Aortic disease, carotid artery disease, hybrid aortic repair, mitochondrial function, peripheral arterial disease, simulator training, spinal cord ischemia, vascular biobank, and vascular trauma

Aortic disease – prognosis, treatment, outcome; new hybrid device for thoracoabdominal aortic repair; spinal cord ischemia.

Peripheral arterial disease – prognosis, diagnosis, outcome and treatment; mitochondrial dysfunction.

Acute lower limb ischemia – Coordination of an international, multicentre, prospective study on outcome of acute limb ischemia.

Vascular trauma – Outcome, prognosis, treatment; Evaluation of new haemostyptic agents in a large animal model.

Vascular biobank

Clinical research covers all main topics of vascular surgery with focus on diagnosis, treatment, prognosis and outcome of vascular diseases: aortic disease (prospective data collection), peripheral arterial disease (retrospective analysis of treatment & outcome), vascular trauma (retrospective analysis of treatment & outcome) and acute limb ischemia (coordination of an international prospective study).

A new graft for thoracoabdominal hybrid aortic repair avoiding thoracotomy and extracorporeal circulation was developed in extensive translational research projects (performed in Hamburg, first 10 patients treated in Hamburg). In 2023, this new modified graft will be used in selective patients in Innsbruck.

Names of Researcher: Sabine Wipper, Florian Enzmann, Alexandra Gratl, Josef Klocker, Michaela Kluckner, David Wippel, Kristina Grassl, Daniela Lobenwein, Maria Moll.

Basics Science – in May 2022, the Laboratory of Basic Science of the Department of Vascular Surgery was inaugurated. Special research interests are: mitochondrial dysfunction in peripheral disease, cellular pathomechanisms in aortic disease and spinal cord ischemia. Additionally, a vascular biobank was established (start of sample collection in autumn 2022).

Name/Names of Researcher: Sabine Wipper, Alexandra Gratl, Daniela Lobenwein, Juliana Heidler, Michaela Kluckner.

Translational research – Special research interests are: new haemostyptic agent; simulator training on endovascular techniques with medical students.

Name/Names of Researcher: Sabine Wipper, Alexandra Gratl, David Wippel, Daniela Lobenwein.

Aortic disease

Aortic disease includes aortic aneurysms as well as aortic dissection with different treatment modalities for these clinical entities. A prospective database has been established to further evaluate incidences, prognosis and outcome of different treatment options. Additionally, our institution is part of a multicentre registry data collection evaluating the outcome of specific endovascular grafts. To further investigate the outcome of patients suffering from aortic dissection, a retrospective database was established including all patients being treated at our institution over the last 20 years.

There is also special focus on the development of a new hybrid graft for treatment of complex aortic diseases. Based on the Thoraflex® hybrid-graft (Vascutek ltd., Glasgow, UK), a new hybrid graft, the Thoracoflo ® hybrid-graft (Vascutek ltd., Glasgow, UK), was developed as a new hybrid device for thoracoabdominal aortic aneurysm (TAAA) repair. After successful completion of first-in-man delivery of the graft, the first implantation within our institution is planned for 2023.

To further investigate cellular pathomechanisms being relevant in the development of aortic diseases, a model including mechanical stress, simulating blood flow within an aneurysm is established in the basic science laboratory. Additionally, using patient sample collection of the newly established vascular biobank, further insights about cellular and molecular alterations in aortic diseases are expected to be defined.

Name/Names of Researcher: Sabine Wipper, Florian Enzmann, Alexandra Gratl, Daniela Lobenwein, David Wippel, Kristina Grassl, Juliana Heidler

Visceral perfusion

Acute mesenteric ischemia requires acute treatment to achieve reperfusion. Bowel ischemia requires surgical resection. Assessment of bowel viability after ischemia is mandatory to determine the resection boundaries. Furthermore, the evaluation of the perfusion in the anastomotic area is important to prevent further damage. Therefore, tissue perfusion of the bowel and gastric tube were evaluated and quantitatively assessed with fluorescent imaging in an experimental setting as a new tool for intraoperative quality control. The study was performed in collaboration with the department of general and visceral surgery of the University Hospital Hamburg Eppendorf.

Name/Names of Researcher: Sabine Wipper

Peripheral arterial disease

In addition to the clinical evaluation of incidences, prognosis and outcome using retrospective databases, new diagnostic tools (hyperspectral imaging as well as fluorescence imaging) for peripheral arterial diseases are evaluated within a prospective cohort study. For this purpose, funding was raised by the Austrian Society of Vascular Surgery.

The clinical applicability of newly gained data from the VOYAGER-PAD trial (comparison of cardiovascular outcome parameters with aspirin with or without additional low-dose rivaroxaban) was evaluated within a prospective single-centre study.

A randomised controlled trial was established to further investigate the effect of different treatment strategies on mitochondrial outcome parameters. Further extension of this project on chronic limb-threatening ischemia is planned.

Name/Names of Researcher: Florian Enzmann, Michaela Kluckner, Sabine Wipper, Josef Klocker, Maria Moll, Alexandra Gratl, Daniela Lobenwein, Juliana Heidler

Acute lower limb ischemia

To investigate incidences, treatment strategies and outcome of patients with acute limb ischemia, a prospective multicentre observational study (PROMOTE-ALI) was initiated by our institution using a European network of vascular researchers.

Name/Names of Researcher: Alexandra Gratl, Florian Enzmann, Michaela Kluckner, Daniela Lobenwein

Vascular trauma

Retrospective data collection about vascular trauma on extremities is performed within our institution. Within the last 2 years, data were published regarding trauma of lower extremities with focus on identification of risk factors for limb amputation.

Within a porcine model, a new haemostyptic agent, based on polyphosphate was tested in a haemorrhagic shock porcine model. Influence on haemodynamics, organ perfusion and efficacy of the haemostypticum compared to control with Combat Gaze ® were evaluated.

Name/Names of Researcher: Sabine Wipper, Alexandra Gratl, Josef Klocker, Michaela Kluckner, Daniela Lobenwein, David Wippel

Vascular Biobank

A vascular biobank with local and international collaboration partner was established by end of 2022 with ongoing sample collection.

Name/Names of Researcher: Daniela Lobenwein, Alexandra Gratl, Juliana Heidler, Sabine Wipper, David Wippel, Michaela Kluckner

Translational research and simulator training

A new vascular research laboratory was established including small and large animal research facilities. Furthermore endovascular treatment strategies were introduced requiring extensive simulator training. This is for peripheral arterial disease. Further studies for endovascular aortic repair are planned.

Name/Names of Researcher: Alexandra Gratl, Daniela Lobenwein, Sabine Wipper, David Wippel, Werner Westreicher, Maria Gummerer, Florian Enzmann

Aortic disease

Lobenwein D, Huber R, Kerbler L, Gratl A, Wipper S, Gollmann-Tepeköylü C, Holfeld J. Neuronal Pre- and Postconditioning via Toll-like Receptor 3 Agonist or Extracorporal Shock Wave Therapy as New Treatment Strategies for Spinal Cord Ischemia: An In Vitro Study. J Clin Med. 2022 Apr 11;11(8):2115. PMID 35456206.

Wipper S, Sandhu HK, Kölbel T, Estrera AL, Trepte C, Behem C, Miller CC 3rd, Debus ES. In vivo evaluation of a new hybrid graft using retrograde visceral perfusion for thoracoabdominal aortic repair in an animal model. JTCVS Tech. 2022 Aug 8;15:1-8. Doi: 10.1016/ j.xjtc.2022.07.022. eCollection 2022 Oct. PMID: 36276707.

Aschacher T, Geisler D, Lenz V, Aschacher O, Winkler B, Schaefer AK, Mitterbauer A, Wolf B, Enzmann FK, Messner B, Laufer G, Ehrlich MP, Grabenwöger M, Bergmann M. Impacts of Telomeric Length, Chronic Hypoxia, Senescence, and Senescence-Associated Sectretory Phenotype on the Development of Thoracic Aortic Aneurysm. INt J Mol Scie. 2022 Dec 7; 23(24):15498. doi:10.3390/ijms232415498. PMID: 36555139.

Debus ES, Malik K, Kölbel T, Honig S, Brickwedel J, Behem C, Wipper SH. First in Human Implantation of the Thoracoflo Graft: A New Hybrid Device for Thoraco-Abdominal Aortic Repair. EJVES Vasc Forum. 2023 Mar 7;58:28-31. doi: 10.1016/j.ejvsvf.2023.02.002. eCollection 2023.PMID: 37006724

Peripheral arterial disease

Enzmann FK, Nierlich P, Hölzenbein T, Aspalter M, kluckner M, Hitzl W, Opperer M, Linni K. Vein Bypass versus Nitinol Stent in Long Femoropopliteal Lesions: 4-Year Results of a Randomized Controlled Trial. Ann Surg. 2022 Feb 17. Doi: 10.1097/SLA. 0000000000005413. Online ahead of print. PMID 35185122.

Kluckner M, Gratl A, Wipper S, Hitzl W, Nierlich P, Aspalter M, Linni K, Enzmann F. Comparison of prosthetic and vein bypass with nitinol stents in long femoropopliteal lesions. Ann Vasc Surg. 2022 Jan;78:272-280. PMID: 34437960

Kluckner M, Nierlich P, Hitzl W, Aschacher T, Gratl A, Wipper S, Aspalter M, Moussalli H, Linni K, Enzmann FK. Long-Term Results of Endovascular Treatment with Nitinol Stents for Femoropopliteal TASC II C and D Lesions. Medicina (Kaunas). 2022 Sep 5;58(9):1225. doi: 10.3390/medicina58091225. PMID: 36143902.

Gratl A, Pesta D, Gruber L, Speichinger F, Raude B, Omran S, Greiner A, Frese J. The effect of revascularization on recovery of mitochondrial respiration in peripheral artery disease: a case control study. J Transl Med. 2021 Jun 4;19(1):244. PMID: 34088309

Moll MA, Zwerger D, Grassl KJ, Westreicher W, Neururer SB, Moll CW, Wipper SH, Klocker J. Prevalence of VOYAGER PAD trial exclusion criteria in unselected patients undergoing lower limb revascularization. J Int Angiol. 2022 Feb;41(1):56-62. Doi: 10.23736/S0392-9590.21.04816-1. PMID: 34913631.
Acute lower limb ischemia

Gratl A, European Vascular Research Collaborative (EVRC). Study Protocol of a Prospective Multicenter Observational Study Evaluating Acute Lower Limb Ischemia. J Surg Res. J Surg Res. 2023 Feb 282:280-4. PMID: 36247128.

Visceral perfusion

Duprée A, Rieß H, von Kroge PH, Izbicki JR, Debus ES, Mann O, Pinnschmidt HO, Russ D, Detter C, Wipper SH. Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) in a porcine model of mesenteric ischemia. PLoS One. 2021 Jul 20;16(7):e0254144. doi: 10.1371/journal.pone.0254144. eCollection 2021.PMID: 34283875

von Kroge P, Russ D, Wagner J, Grotelüschen R, Reeh M, Izbicki JR, Mann O, Wipper SH, Duprée A. Quantification of gastric tube perfusion following esophagectomy using fluorescence imaging with indocyanine green. Langenbecks Arch Surg. 2022 Nov;407(7):2693-2701. doi: 10.1007/s00423-022-02546-0.

von Kroge PH, Russ D, Rieß HC, Debus ES, Pinnschmidt HO, Izbicki JR, Mann O, Wipper SH, Duprée A. The impact of nitroglycerine and volume on gastric tube microperfusion assessed by indocyanine green fluorescence imaging. Sci Rep. 2022 Dec 27;12(1):22394. doi: 10.1038/s41598-022-26545-9.

Vascular trauma

Kluckner M, Gratl A, Gruber L, Frech A, Gummerer M, Wipper S, Enzmann FK, Klocker J. Risk factors for major amputation after arterial vascular trauma if the lower extremity. J Scand Surg. 2022 Jan-Mar;111(1):14574969211070668. PMID: 35188006.

Kluckner M, Gratl A, Gruber L, Frech A, Gummerer M, Enzmann FK, Wipper S, Klocker J. Predictors for the need for fasciotomy after arterial vascular trauma of the lower extremity. Injury. 2021 Aug;52(8):2160-65. PMID: 34130853

Gratl A, Kluckner M, Gruber L, Klocker J, Enzmann FK, Wipper S. The Mangled Extremity Severity Score (MESS) does not predict amputation in popliteal artery injury. Eur J Trauma Emerg Surg. 2022 Nov 30. doi:10.1007/s00068-022-02179-4. PMID: 36449024.

Behem CR, Haunschild J, Pinnschmidt HO, Gaeth C, Graessler MF, Trepte CJC, Etz CD, Debus ES, Wipper SH. Effects of fluids vs. vasopressors on spinal cord microperfusion in hemorrhagic shock induced ischemia/reperfusion. Microvasc Res. 2022 Sep;143:104383. doi: 10.1016/j.mvr.2022.104383.

Behem CR, Graessler MF, Friedheim T, Kluttig R, Pinnschmidt HO, Duprée A, Debus ES, Reuter DA, Wipper SH, Trepte CJC. The use of pulse pressure variation for predicting impairment of microcirculatory blood flow. Sci Rep. 2021 Apr 28;11(1):9215. doi: 10.1038/s41598-021-88458-3.

Translational research and simulator training

Simon F, Larena-Avellaneda A, Wipper S. Experimental Atherosclerosis Research on Large and Small Animal Models in Vascular Surgery. J Vasc Res. 2022;59(4):221-228. doi: 10.1159/000524795.

Gratl A, Lobenwein D, Gummerer M, Wipper S. Establishment of a new research concept at a university location]. Gefasschirurgie. 2022;27(4):239-245. doi: 10.1007/s00772-022-00900-6.

Gratl A, Wipper S, Frese JP, Raude B, Greiner A, Pesta D. The Role of Mitochondrial Function in Peripheral Arterial Disease: Insights from Translational Studies. Int J Mol Sci. 2021 Aug 6;22(16):8478. doi: 10.3390/ijms22168478.

von Kroge P, Russ D, Wagner J, Grotelüschen R, Reeh M, Izbicki JR, Mann O, Wipper SH, Duprée A. Quantification of gastric tube perfusion following esophagectomy using fluorescence imaging with indocyanine green. Langenbecks Arch Surg. 2022 Nov;407(7):2693-2701. doi: 10.1007/s00423-022-02546-0.

von Kroge PH, Russ D, Rieß HC, Debus ES, Pinnschmidt HO, Izbicki JR, Mann O, Wipper SH, Duprée A. The impact of nitroglycerine and volume on gastric tube microperfusion assessed by indocyanine green fluorescence imaging. Sci Rep. 2022 Dec 27;12(1):22394. doi: 10.1038/s41598-022-26545-9.

Sabine Wipper – Research funding transferred from University Hospital Hamburg 49.840,66€ 

Florian Enzmann – Research Prize of the Austrian Society of Surgery 2022 – 5.000,00€

Daniela Lobenwein –  Jörg-Vollmar-Preis” of the German Society of Vascular Surgery 2021 – 5.000,00€

Michaela Kluckner – “Nachwuchsförderung” of the Austrian Society of Vascular Surgery 2022 – 10.000,00€

Alexandra Gratl – Project specific funding of Medtronic Austria GmbH 2023 – 10.000,00€

Department of Vascular Medicine, University Heart & Vascular Centre Hamburg Eppendorf, German Aortic Center, Hamburg, Germany

Department of Vascular Surgery, RWTH Aachen/Maastricht, Germany/Netherlands

Department of Vascular and Endovascular Surgery, UKM Muenster, Germany

Clinic of Vascular Surgery, Charité University Hospital of Berlin, Germany

Zena and Michael A. Wiender Cardiovascular Institute Icahn School of Medicine at Mount Sinai Hospital, New York, USA

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, Houston, USA

Department of Vascular Surgery, Hospital das Clinicas, Medical Faculty, Sao Paolo, Brasil

Department of Cardiothoracic Surgery, Rikkshospitalet, University Hospital Oslo, Oslo, Norway

Department of Surgery (Division of Cardiac Surgery), Medical University Vienna, Austria

European Vascular Research Collaboration