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Rief M, Rief A, Bornemann-Cimenti H, Rief P. Idiopathic pseudoaneurysm of the popliteal artery with endovascular treatment: A case report. Radiol Case Rep 2023; 18:3336-3340. [PMID: 37502134 PMCID: PMC10368536 DOI: 10.1016/j.radcr.2023.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Popliteal pseudoaneurysms are a rare vascular pathology, usually caused by trauma or iatrogenic interventions. Idiopathic cases are exceptionally uncommon. This case report aims to describe the diagnosis and successful endovascular treatment of an idiopathic pseudoaneurysm of the popliteal artery in a 90-year-old bedridden female patient presented with acute pain and swelling in the left knee at the emergency department. The patient underwent successful endovascular treatment with a covered stent and thrombin injection, leading to complete exclusion of the pseudoaneurysm. Popliteal pseudoaneurysms are a rare pathology, and idiopathic cases are even more uncommon. Endovascular therapy for popliteal pseudoaneurysms is associated with lower morbidity and mortality rates compared to open surgical repair. This case report highlights the importance of interdisciplinary collaboration between vascular surgeons and interventional radiologists in the management of rare vascular pathologies.
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Affiliation(s)
- Martin Rief
- Division of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Angelika Rief
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Helmar Bornemann-Cimenti
- Division of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Clinical Department of Angiology, Medical University of Graz, Graz, Austria
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2
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Jeong K, Murphy JM, Kim JH, Campbell PM, Park H, Rodriguez Y, Choi C, Kim JS, Park S, Kim HJ, Scammell JG, Weber DS, Honkanen RE, Schlaepfer DD, Ahn EYE, Lim STS. FAK Activation Promotes SMC Dedifferentiation via Increased DNA Methylation in Contractile Genes. Circ Res 2021; 129:e215-e233. [PMID: 34702049 DOI: 10.1161/circresaha.121.319066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale: Vascular smooth muscle cells (SMCs) exhibit remarkable plasticity and can undergo dedifferentiation upon pathological stimuli associated with disease and interventions. Objective: Although epigenetic changes are critical in SMC phenotype switching, a fundamental regulator that governs the epigenetic machineries regulating the fate of SMC phenotype has not been elucidated. Methods and Results: Using SMCs, mouse models, and human atherosclerosis specimens, we found that focal adhesion kinase (FAK) activation elicits SMC dedifferentiation by stabilizing DNA methyltransferase 3A (DNMT3A). FAK in SMCs is activated in the cytoplasm upon serum stimulation in vitro or vessel injury and active FAK prevents DNMT3A from nuclear FAK-mediated degradation. However, pharmacological or genetic FAK catalytic inhibition forced FAK nuclear localization, which reduced DNMT3A protein via enhanced ubiquitination and proteasomal degradation. Reduced DNMT3A protein led to DNA hypomethylation in contractile gene promoters, which increased SMC contractile protein expression. RNA sequencing identified SMC contractile genes as a foremost upregulated group by FAK inhibition from injured femoral artery samples compared to vehicle group. DNMT3A knockdown in injured arteries reduced DNA methylation and enhanced contractile gene expression supports the notion that nuclear FAK-mediated DNMT3A degradation via E3 ligase TRAF6 drives differentiation of SMCs. Furthermore, we observed that SMCs of human atherosclerotic lesions exhibited decreased nuclear FAK, which was associated with increased DNMT3A levels and decreased contractile gene expression. Conclusions: This study reveals that nuclear FAK induced by FAK catalytic inhibition specifically suppresses DNMT3A expression in injured vessels resulting in maintaining SMC differentiation by promoting the contractile gene expression. Thus, FAK inhibitors may provide a new treatment option to block SMC phenotypic switching during vascular remodeling and atherosclerosis.
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Affiliation(s)
- Kyuho Jeong
- Biochemistry and Molecular Biology, University of South Alabama College of Medicine, UNITED STATES
| | - James M Murphy
- Biochemistry and Molecular Biology, University of South Alabama College of Medicine, UNITED STATES
| | - Jung-Hyun Kim
- Biochemistry and Molecular Biology, University of South Alabama College of Medicine, UNITED STATES
| | | | - Hyeonsoo Park
- Biochemistry and Molecular Biology, University of South Alabama College of Medicine, KOREA, REPUBLIC OF
| | - Yelitza Rodriguez
- Biochemistry and Molecular Biology, University of South Alabama College of Medicine, UNITED STATES
| | - Chungsik Choi
- Physiology, University of South Alabama College of Medicine, UNITED STATES
| | - Jun-Sub Kim
- Biotechnology, Korea National University of Transportation, KOREA, REPUBLIC OF
| | - Sangwon Park
- Pharmacology, Gyeongsang National University, KOREA, REPUBLIC OF
| | - Hyun Joon Kim
- Anatomy and Convergence Medical Sciences, Gyeongsang National University
| | - Jonathan G Scammell
- Comparative Medicine, University of South Alabama College of Medicine, UNITED STATES
| | - David S Weber
- Physiology and Cell Biology, University of South Alabama College of Medicine, UNITED STATES
| | - Richard E Honkanen
- Biochemistry and Molecualr Biology, University of South Alabama College of Medicine, UNITED STATES
| | - David D Schlaepfer
- Obstetrics, Gynecology, and Reproductive Medicine, University of California, San Diego Moores Cancer Center, UNITED STATES
| | | | - Ssang-Taek Steve Lim
- Biochemistry and Molecular Biology, University of South Alabama College of Medicine, UNITED STATES
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Nakabayashi K, Hata S, Kaneko N, Matsui A, Tanaka K, Ando H, Shimizu M. Pseudo-aneurysm caused by stent fracture in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions. J Cardiol Cases 2020; 22:11-14. [PMID: 32636961 DOI: 10.1016/j.jccase.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/14/2020] [Indexed: 10/24/2022] Open
Abstract
Despite the reported favorable patency of stents in the treatment of femoropopliteal lesions, concern regarding stent fracture is increasing. Development of pseudo-aneurysm by stent fracture is rare and has been reported to occur in the chronic phase owing to mechanical fatigue. Here, we present the first report of a pseudo-aneurysm caused by stent fracture in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesion. A 79-year-old man underwent endovascular therapy for an in-stent restenosis lesion of the right superficial femoral artery. Echography 48 days after the treatment showed a saccular pseudo-aneurysm at the proximal stent site, suggestive of stent fracture. Angiography confirmed the pseudo-aneurysm caused by stent fracture. A self-expandable endoluminal stent graft was deployed, which showed complete resolution of the pseudo-aneurysm. A pseudo-aneurysm caused by stent fracture can occur in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions. <Learning objective: Although rare, a pseudo-aneurysm owing to stent fracture can occur in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions.>.
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Affiliation(s)
| | - Shinya Hata
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Nobuhito Kaneko
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Akihiro Matsui
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Kazuhiko Tanaka
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Hiroshi Ando
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
| | - Minoru Shimizu
- Kasukabe Chuo General Hospital, Heart Center, Saitama, Japan
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Bilman V, Ardita V, Grandi A, Chiesa R, Bertoglio L. Symptomatic superficial femoral artery pseudoaneurysm due to late stent fracture. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:106-109. [PMID: 32095668 PMCID: PMC7033464 DOI: 10.1016/j.jvscit.2019.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022]
Abstract
Late formation of pseudoaneurysm related to stent fracture is rarely described in the literature. We describe a case of spontaneous 8-cm femoral superficial artery pseudoaneurysm rupture that had developed from fracture of a stent implanted 3 years previously. Surgical repair was performed with fractured stent removal and reverse saphenous vein bypass.
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Affiliation(s)
- Victor Bilman
- Cirurgia Vascular e Endovascular, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
| | - Vincenzo Ardita
- Division of Vascular Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Alessandro Grandi
- Division of Vascular Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
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Dos Reis JMC, Kudo FA, do Carmo Bastos M. Fracture of a popliteal nitinol stent and pseudoaneurysm: a case report and review of the literature. J Surg Case Rep 2019; 2019:rjz312. [PMID: 31737245 PMCID: PMC6847879 DOI: 10.1093/jscr/rjz312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/21/2019] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
There is a lack of reports onr stent fracture with pseudoaneurysm formation in the femoropopliteal artery, which can cause restenosis or occlusion of the treated arterial segment. We present a case of a large pseudoaneurysm of the popliteal artery that was observed 18 months after popliteal stenting using a self-expandable nitinol stent. We describe an endovascular approach to overcome this severe complication. Stent fractures are an often overlooked complication of femoropopliteal stenting and can be associated with serious diseases. The popliteal artery was successfully treated using self-expandable Viabahn endoprosthesis.
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Rahimi M, Robertson B, Doctor LM, Bath J. Successful Management of Arterial Pseudoaneurysm Caused by Stent Fracture. Ann Vasc Surg 2017; 41:281.e11-281.e14. [PMID: 28242394 DOI: 10.1016/j.avsg.2016.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/09/2023]
Abstract
Pseudoaneurysm is a relatively common complication of arterial injury. Arterial pseudoaneurysms have many different etiologies, including trauma, iatrogenic injury, vascular repair, infection, and vasculitides. In this case report, we present a pseudoaneurysm created by a fracture of superficial femoral artery (SFA) stent secondary to a mechanical fall. To our knowledge, this is the first report of a symptomatic pseudoaneurysm caused by a SFA stent fracture. The large, unruptured pseudoaneurysm in this case was successfully treated with a covered stent and pseudoaneurysm exclusion.
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Affiliation(s)
- Maham Rahimi
- Department of Vascular Surgery, University of Cincinnati, Cincinnati, OH.
| | - Brent Robertson
- Department of Vascular Surgery, University of Cincinnati, Cincinnati, OH
| | - Lynne M Doctor
- Department of Vascular Surgery, University of Cincinnati, Cincinnati, OH
| | - Jonathan Bath
- Department of Vascular Surgery, University of Cincinnati, Cincinnati, OH
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Bath J, Avgerinos E. A pooled analysis of common femoral and profunda femoris endovascular interventions. Vascular 2016; 24:404-13. [DOI: 10.1177/1708538115604929] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atherosclerotic disease of common femoral and profunda femoris arteries has been historically treated with surgical endarterectomy. Endovascular treatment of common femoral artery and profunda femoris artery disease is increasingly reported in the recent literature. This review summarizes short- and mid-term outcomes of endovascular interventions to the common femoral artery and common femoral artery. Methods All published series in the English language were identified through a systematic PubMed search. Standard descriptive statistics, reported as mean ± SD, were applied to perform the pooled analysis and calculate the overall outcome measures. Combined overall effect sizes were calculated using fixed-effect meta-analysis. Results The analysis included 20 studies with a total of 836 patients (897 limbs, mean age of 70.5 ± 4.3 years, critical limb ischemia 39.6%). Technical success was 95%. Angioplasty alone was undertaken in 68.8% of cases and stenting in 22.3%. Access complications occurred in 2.4% of cases. Post-operative major adverse limb events occurred in 2% and major adverse cardiovascular events in 1% of cases. Primary patency at 6, 12 and 24 months was 87%, 77% and 73%, respectively. Subgroup analysis revealed a significantly higher mean primary patency at 12 months for routine stenting compared to a selective stenting strategy (91.4% versus 75%; p < 0.05). Conclusions Endovascular interventions to the common femoral artery and common femoral artery can be performed safely with high technical success. Endovascular therapy may be a favored approach over endarterectomy for highly selected patients of poor surgical risk, with limited life expectancy and those with wound-healing considerations such as re-operative fields or prone to infection.
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Affiliation(s)
- Jonathan Bath
- Division of Vascular Surgery, Department of Surgery, University of Cincinnati, Cincinnati, USA
| | - Efthymios Avgerinos
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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Lee YJ, Shin DH, Kim JS, Kim BK, Ko YG, Hong MK, Jang Y, Choi D. Femoropopliteal Artery Stent Fracture with Recurrent In-Stent Reocclusion and Aneurysm Formation: Successful Treatment with Self-Expandable Viabahn Endoprosthesis. Korean Circ J 2015; 45:522-5. [PMID: 26617656 PMCID: PMC4661369 DOI: 10.4070/kcj.2015.45.6.522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/04/2015] [Accepted: 04/02/2015] [Indexed: 11/21/2022] Open
Abstract
Primary stenting in femoropopliteal lesions of intermediate length has recently shown favorable outcomes. However, stent fractures are a concern after bare metal stent implantation. The incidence of stent fracture varies widely (ranging from 2% to 65%) depending on factors such as the treated lesions or stent type and may potentially lead to various complications. We reported a case of stent fracture with complete dislocation combined with recurrent in-stent reocclusion and aneurysm formation in a patient with occlusive disease of the femoropopliteal artery, which was successfully treated with self-expandable endovascular stent graft.
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Affiliation(s)
- Yong-Joon Lee
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Dong-Ho Shin
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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9
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Dumantepe M, Seren M, Fazlıogullari O, Ayoglu U, Teymen B. Treatment of complex atherosclerotic femoropopliteal artery disease with a self-expanding interwoven nitinol stent: Midterm results. Vascular 2015; 29:711-719. [PMID: 25687718 DOI: 10.1177/1708538114568884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the efficacy and durability of an interwoven self-expanding nitinol stent for the treatment of superficial femoral and popliteal arteries. METHOD Consecutive patients with severely diseased superficial femoral and popliteal arteries who received SUPERA® stents were retrospectively identified. The patients were followed for 12 months by Doppler ultrasound examinations, stent roentgenograms, and estimation of Rutherford-Becker class and ankle-brachial index. RESULTS From July 2012 to May 2014, 42 limbs in 36 patients (mean age, 61.5 ± 7.5 years; 75% male) were treated with angioplasty and primary stenting. Total occlusions were present in 14 limbs, and 63.8% had either moderate or severe calcification. The mean (±SD) lesion length was 105 mm (±28). Primary patency was 91.4% at 6 months and 85.7% at 12 months. The ankle brachial index increased from 0.57 ± 0.19 preoperative to 0.91 ± 0.12 postoperative. There was no procedural or device-related morbidity or mortality after revascularization and only one major amputation was observed on follow-up. CONCLUSIONS Our experience shows that, Supera stents are safe and effective in our cohort of patients, with acceptable patency rates. There were no stent fractures so far even with stenting of the femoropopliteal segments. Stent design provides a viable option for high-grade obstructive disease in the femoropopliteal artery.
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Affiliation(s)
- Mert Dumantepe
- Department of Cardiology, Medical Park Gebze Hospital, Istanbul, Turkey
| | - Mustafa Seren
- Department of Cardiovascular Surgery, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | | | - Umut Ayoglu
- Department of Cardiology, Medical Park Gebze Hospital, Istanbul, Turkey
| | - Burak Teymen
- Department of Cardiology, Medical Park Gebze Hospital, Istanbul, Turkey
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Oliveira GDP, Guillaumon AT, Brito IBD, Lima JMT, Benvindo SC, Santos LGD. Idiopathic popliteal artery pseudoaneurysm: emergency diagnosis and treatment. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pseudoaneurysms or false aneurysms of the popliteal artery are uncommon arterial disorders. These disorders most commonly result from trauma and iatrogenic lesions following orthopedic procedures. The authors report a rare case of popliteal artery pseudoaneurysm in which etiology was unknown. The authors also demonstrate that Doppler ultrasonography may be sufficient for planning vascular surgical procedures and that the open surgical approach is the treatment of choice for cases in which the symptomatic lesion causes local compression.
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Chan YC, Cheng SW, Ting AC, Cheung GC. Primary stenting of femoropopliteal atherosclerotic lesions using new helical interwoven nitinol stents. J Vasc Surg 2014; 59:384-91. [DOI: 10.1016/j.jvs.2013.08.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/21/2013] [Accepted: 08/21/2013] [Indexed: 10/25/2022]
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Huynh KD, Mafi HM, Budtz-Lilly JW, Eldrup N. A symptomatic pseudoaneurysm caused by stent fracture in the external iliac artery. Vascular 2013; 21:335-7. [PMID: 23518843 DOI: 10.1177/1708538113478753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2012] [Indexed: 11/16/2022]
Abstract
Pseudoaneurysms, as a result of endovascular stent fracture, are a rare yet important vascular surgery complication. A 64-year-old man presented with a painful mass in the left groin with accompanying critical ischemia of the left leg. Diagnostic angiography revealed a pseudoaneurysm caused by stent fracture in the left external iliac artery. The patient was treated with embolization of the left external iliac artery and ultimately above-the-knee amputation. Awareness of this uncommon complication is important due to its potential risk of severe disability.
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Affiliation(s)
| | - Hossain Mohit Mafi
- Department of Radiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Results of polytetrafluoroethylene-covered nitinol stents crossing the inguinal ligament. J Vasc Surg 2013; 57:421-6. [DOI: 10.1016/j.jvs.2012.05.112] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/09/2012] [Accepted: 05/27/2012] [Indexed: 11/17/2022]
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