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Sörelius K, Wanhainen A, Furebring M, Björck M, Gillgren P, Mani K, Lindström D, Hultgren R, Wahlgren CM, Roos H, Langenskiöld M, Resch T, Vaccarino R, Bilos L, Pirouzram A, Arnerlöv C, Simo G, Svensson M, Magnusson J, Astrand H, Gilgen NP, Mellander S, Korman D, Djavani-Gidlund K, Palm M, Huss M, Bertszel A, Docter M, Drott C, Öjersjö A, Nelzén O, Wetterling T, Chu M. Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair. Circulation 2016; 134:1822-1832. [DOI: 10.1161/circulationaha.116.024021] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022]
Abstract
Background:
No reliable comparative data exist between open repair (OR) and endovascular aneurysm repair (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR and EVAR for MAAA in a population-based cohort.
Methods:
All patients treated for MAAAs in Sweden between 1994 and 2014 were identified in the Swedish vascular registry. The primary aim was to assess survival after MAAA with OR and EVAR. Secondary aims were analyses of the rate of recurrent infections and reoperations, and time trends in surgical treatment. Survival was analyzed using Kaplan-Meier and log-rank tests. A propensity score–weighted correction for risk factor differences in the 2 groups was performed, including the operation year to account for differences in treatment and outcomes over time.
Results:
We identified 132 patients (0.6% of all operated abdominal aortic aneurysms in Sweden). Mean age was 70 years (standard deviation, 9.2), and 50 presented with rupture. Survival at 3 months was 86% (95% confidence interval, 80%–92%), at 1 year 79% (72%–86%), and at 5 years 59% (50%–68%). The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994–2000 0%, 2001–2007 58%, 2008–2014 60%). Open repair was performed in 62 patients (47%): aortic resection and extra-anatomic bypass (n=7), in situ reconstruction (n=50), and patch plasty (n=3); 2 patients died intraoperatively. EVAR was performed in 70 patients (53%): standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stent grafting (n=7); no deaths occurred intraoperatively. Survival at 3 months was lower for OR than for EVAR (74% versus 96%,
P
<0.001), with a similar trend present at 1 year (73% versus 84%,
P
=0.054). A propensity score–weighted risk-adjusted analysis confirmed the early better survival associated with EVAR. During median follow-up of 36 and 41 months for OR and EVAR, respectively, there was no difference in long-term survival (5 years 60% versus 58%,
P
=0.771), infection-related complications (18% versus 24%,
P
=0.439), or reoperation (21% versus 24%,
P
=0.650).
Conclusion:
This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR was associated with improved short-term survival in comparison with OR, without higher associated incidence of serious infection-related complications or reoperations.
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Affiliation(s)
- Karl Sörelius
- From Department of Surgical Sciences, Section of Vascular Surgery (K.S., A.W., M.B., K.M.), Department of Medical Sciences, Section of Infectious Diseases (M.F.), Uppsala University, Sweden; and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (P.G.)
| | - Anders Wanhainen
- From Department of Surgical Sciences, Section of Vascular Surgery (K.S., A.W., M.B., K.M.), Department of Medical Sciences, Section of Infectious Diseases (M.F.), Uppsala University, Sweden; and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (P.G.)
| | - Mia Furebring
- From Department of Surgical Sciences, Section of Vascular Surgery (K.S., A.W., M.B., K.M.), Department of Medical Sciences, Section of Infectious Diseases (M.F.), Uppsala University, Sweden; and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (P.G.)
| | - Martin Björck
- From Department of Surgical Sciences, Section of Vascular Surgery (K.S., A.W., M.B., K.M.), Department of Medical Sciences, Section of Infectious Diseases (M.F.), Uppsala University, Sweden; and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (P.G.)
| | - Peter Gillgren
- From Department of Surgical Sciences, Section of Vascular Surgery (K.S., A.W., M.B., K.M.), Department of Medical Sciences, Section of Infectious Diseases (M.F.), Uppsala University, Sweden; and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (P.G.)
| | - Kevin Mani
- From Department of Surgical Sciences, Section of Vascular Surgery (K.S., A.W., M.B., K.M.), Department of Medical Sciences, Section of Infectious Diseases (M.F.), Uppsala University, Sweden; and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (P.G.)
| | - David Lindström
- Department of Vascular Surgery, Karolinska Hospital, Stockholm
| | | | | | - Håkan Roos
- Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg
| | - Marcus Langenskiöld
- Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg
| | | | | | - Linda Bilos
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro
| | - Artai Pirouzram
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro
| | - Conny Arnerlöv
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University Hospital, Umeå
| | - Gabor Simo
- Department of Surgery, Central Hospital Karlstad, Karlstad
| | | | | | - Håkan Astrand
- Department of Surgery, Jönköping Hospital, Jönköping
| | | | | | - David Korman
- Department of Surgery, Östersunds Hospital, Östersund
| | | | - Markus Palm
- Department of Surgery, Sunderby Hospital, Sunderbyn
| | - Mårten Huss
- Department of Thoracic and Vascular Surgery, and Department of Medical and Health Sciences, Linköping University, Linköping
| | - Adam Bertszel
- Department of Vascular Surgery, Västerås Hospital, Västerås
| | | | | | | | - Olle Nelzén
- Department of Vascular Surgery, Skaraborg Hospital, Skoevde
| | | | - Ming Chu
- Department of Surgery, Regional Hospital Sundsvall, Sundsvall
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Sörelius K, Mani K, Björck M, Sedivy P, Wahlgren CM, Taylor P, Clough RE, Lyons O, Thompson M, Brownrigg J, Ivancev K, Davis M, Jenkins MP, Jaffer U, Bown M, Rancic Z, Mayer D, Brunkwall J, Gawenda M, Kölbel T, Jean-Baptiste E, Moll F, Berger P, Liapis CD, Moulakakis KG, Langenskiöld M, Roos H, Larzon T, Pirouzram A, Wanhainen A. Endovascular Treatment of Mycotic Aortic Aneurysms. Circulation 2014; 130:2136-42. [DOI: 10.1161/circulationaha.114.009481] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Karl Sörelius
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Kevin Mani
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Martin Björck
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Petr Sedivy
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Carl-Magnus Wahlgren
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Peter Taylor
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Rachel E. Clough
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Oliver Lyons
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Matt Thompson
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Jack Brownrigg
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Krassi Ivancev
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Meryl Davis
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Michael P. Jenkins
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Usman Jaffer
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Matt Bown
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Zoran Rancic
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Dieter Mayer
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Jan Brunkwall
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Michael Gawenda
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Tilo Kölbel
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Elixène Jean-Baptiste
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Frans Moll
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Paul Berger
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Christos D. Liapis
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Konstantinos G. Moulakakis
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Marcus Langenskiöld
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Håkan Roos
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Thomas Larzon
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Artai Pirouzram
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
| | - Anders Wanhainen
- From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy’s & St. Thomas’ Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George’s Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of
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