1
|
Mangel T, Mastracci TM. Outcomes of endovascular repair of abdominal and thoracoabdominal aneurysms in women - A review. Semin Vasc Surg 2022; 35:334-340. [DOI: 10.1053/j.semvascsurg.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
|
2
|
Shearkhani O, Rohringer TJ, Eisenberg N, Mafeld S, Tan KT, Jaberi A, Roche-Nagle G. Effect of vertebral compression fractures on aortic neck angulation after endovascular aneurysm repair. J Vasc Surg 2021; 75:1598-1604. [PMID: 34742887 DOI: 10.1016/j.jvs.2021.10.025] [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: 06/24/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Aortic neck angulation (ANA) prior to endovascular aneurysm repair (EVAR) and its changes after EVAR are considered important predictors of postoperative complications. We sought to assess the effects of vertebral body height loss on ANA in patients post-EVAR. METHODS All patients who had undergone EVAR for infrarenal aortic aneurysms in our institution between August 2010 and December 2018 were assessed. Anterior and posterior vertebral body heights were measured in all patients on preoperative, early postoperative, and follow-up computed tomography scans (T12-L5 vertebral bodies). Patients who had significant height loss in their follow-up period were designated as the Study group. These were matched to a Control group of the same size using propensity-score matching based on age, gender, and duration between follow-up scans. Aortic neck morphology indices including ANA and its changes were measured, and information related to postoperative endoleaks and aneurysm sac size were extracted in the Study and Control groups. RESULTS During the follow-up period, 10 of 185 patients had a radiologically significant vertebral body compression fracture. There was no significant difference between the Study (n = 10) and Control groups in age (77.6 ± 6.9 vs 77.2 ± 7.5 years; P = .64), gender (seven males and three females in each group; P = 1.0), duration between postoperative scans (1830 ± 665 vs 1800 ± 670 days; P = .25), preoperative ANA (36.0° ± 15.6° vs 42.4° ± 18.6°; P = .41), and early postoperative ANA (21.9° ± 11.7° vs 20.9° ± 16.3°; P = .72). Changes in ANA in the postoperative period (7.2° ± 11.1° vs -4.7° ± 6.7°; P = .009; power = .838) were significantly higher in the Study group. CONCLUSION Post-EVAR vertebral body compression fractures exacerbate ANA. Awareness of this can guide both preoperative assessment and postoperative management and follow-up.
Collapse
Affiliation(s)
- Omid Shearkhani
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Taryn J Rohringer
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Eisenberg
- Department of Vascular Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kong T Tan
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Arash Jaberi
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada; Department of Vascular Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Tumer NB, Askin G, Akkaya BB, Civelek I, Unal EU, Iscan HZ. Outcomes after EVAR in females are similar to males. BMC Cardiovasc Disord 2021; 21:301. [PMID: 34130661 PMCID: PMC8207773 DOI: 10.1186/s12872-021-02114-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/07/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Women are less likely to develop infrarenal abdominal aortic aneurysm; however, when they do, it is almost always associated with challenging anatomy, more rapid aneurysmal growth rate and earlier rupture. Women generally have poorer outcomes following open aneurysm repair; and in this respect, the present study aims to evaluate if it is so after endovascular repair. METHODS A retrospective analysis of our database was performed for patients underwent endovascular aneurysm repair (EVAR) between January 2013-March 2020. 249 elective EVAR patients were evaluated. Patients were categorized according to gender and 26 patients (10.4%) were female. Demographics and pre-peri-postoperative findings were compared. Propensity score matching (ratio 1:1) was performed to reduce selection bias. RESULTS In the overall unmatched cohort, female population had more diabetes mellitus (p = 0.016) and hypertension (p = 0.005). However, coronary artery disease (p = 0.005) and coronary artery bypass grafting (p = 0.006) were more in male gender. Non-IFU implantation was higher in female group (38.5% vs. 11.5%, p = 0.025). After propensity matching, even though it was not statistically significant, early mortality for female gender was higher when compared to male gender (7.7% and 0%, respectively, p = 0.490). In the follow-up period, no difference in all-cause mortality, secondary interventions or complications have been observed between the genders. CONCLUSION Challenging anatomy and subsequently treated patients outside IFU may be the reasons for higher morbidity and mortality in women. However, despite these factors female and male patients revealed equivalent early and late results.
Collapse
Affiliation(s)
- Naim Boran Tumer
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Goktan Askin
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | | | - Isa Civelek
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ertekin Utku Unal
- Department of Cardiovascular Surgery, Hitit University Erol Olcok Training and Research Hospital, Çorum, Turkey
| | - Hakki Zafer Iscan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
4
|
Erben Y, Bews KA, Hanson KT, Da Rocha-Franco JA, Money SR, Stone W, Farres H, Meltzer AJ, Gloviczki P, Oderich GS, Hakaim AG, Habermann EB. Female Sex is a Marker for Higher Morbidity and Mortality after Elective Endovascular Aortic Aneurysm Repair: A National Surgical Quality Improvement Program Analysis. Ann Vasc Surg 2020; 69:1-8. [DOI: 10.1016/j.avsg.2020.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 01/27/2023]
|
5
|
Hwang D, Kim J, Kim HK, Huh S. Suitability of the Aortic Neck Anatomy for Endovascular Aneurysm Repair in Korean Patients with Abdominal Aortic Aneurysm. Vasc Specialist Int 2020; 36:71-81. [PMID: 32611839 PMCID: PMC7333089 DOI: 10.5758/vsi.200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/09/2020] [Accepted: 05/18/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the aortic neck anatomy in Korean patients with abdominal aortic aneurysms (AAAs). Materials and Methods We examined computed tomography scans of 343 patients with AAAs (≥5.5 cm for men or ≥5 cm for women) between 2009 and 2018. Eligibility of neck anatomy for endovascular aneurysm repair (EVAR) was assessed with the standard instructions for use (IFU) (length ≥15 mm, suprarenal angulation (SRA) ≤45°, infrarenal angulation (IRA) ≤60°, and diameter 18-32 mm) and the extended IFU (length ≥10 mm, SRA ≤60°, IRA ≤75°, and diameter 17-32 mm). Results There were 71 women (20.7%), and 61 patients (17.8%) with rupture. Women had smaller neck diameters (21.3 vs. 23.4 mm, P<0.001 for proximal neck; 22.2 vs. 24.5 mm, P<0.001 for distal neck), and higher angulations (51.5° vs. 37.8°, P<0.001 for SRA; 77.7° vs. 57.0°, P<0.001 for IRA) than men. However, the neck length was not significantly different. Patients with ruptured AAAs had shorter neck lengths (21.0 vs. 26.8 mm, P=0.005) than those with intact AAAs. However, the neck diameters and angulations were not significantly different. EVAR eligibility for standard and extended IFUs was found in 37.5% and 55.1% of men, and 11.3% and 25.4% of women (P<0.001 for both IFUs); neck anatomy was eligible in 34.0% of intact AAAs and 23.0% of ruptured AAAs (P=0.098). Conclusion A significant proportion of the Korean patients did not meet the IFU for EVAR, mainly due to the angulated neck. Women, and patients with ruptured AAAs, were less likely to meet the IFU criteria.
Collapse
Affiliation(s)
- Deokbi Hwang
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jihye Kim
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyung-Kee Kim
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
6
|
Systematic review and meta-analysis of sex differences in outcomes after endovascular aneurysm repair for infrarenal abdominal aortic aneurysm. J Vasc Surg 2020; 71:283-296.e4. [DOI: 10.1016/j.jvs.2019.06.105] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
|
7
|
Varkevisser RRB, Swerdlow NJ, Verhagen HJM, Lyden SP, Schermerhorn ML. Similar 5-year outcomes between female and male patients undergoing elective endovascular abdominal aortic aneurysm repair with the Ovation stent graft. J Vasc Surg 2019; 72:114-121. [PMID: 31843301 DOI: 10.1016/j.jvs.2019.08.275] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Female patients undergoing endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysms present with more challenging anatomy and historically have worse outcomes compared with men. The Ovation Abdominal Stent Graft platform (Endologix, Irving, Calif) contains a polymer-filled proximal sealing ring and has a low-profile delivery system, potentially beneficial in female patients. We therefore investigated differences in long-term outcomes between men and women treated with this device. METHODS We used data collected prospectively in the Effectiveness of Custom Seal with Ovation: Review of the Evidence (ENCORE) database, comprising five trials and the European Post-Market Registry. Anatomic characteristics of the proximal aneurysm neck and iliac arteries were compared between male and female patients. Outcomes were 5-year freedom from type IA and type I/III endoleaks, abdominal aortic aneurysm-related reinterventions, and overall survival. We used Kaplan-Meier analysis to estimate survival proportions and tested univariate differences in survival using log-rank tests. Cox proportional hazards modeling was used to adjust for baseline differences. RESULTS We identified 1045 (81%) male and 251 (19%) female patients undergoing EVAR. Female patients were older (mean age, 75 ± 8.4 years vs 73 ± 8.1 years; P < .006). Aneurysm diameter (52 ± 7.5 mm vs 55 ± 9.2 mm; P < .001) and proximal neck diameter (21 ± 3.3 mm vs 23 ± 2.9 mm; P < .001) were smaller in female patients, but adjusted for body surface area, female patients had relatively larger aneurysms and aneurysm necks. Furthermore, female patients presented with shorter proximal necks, smaller iliac artery diameters, more angulated necks, and higher rates of reverse-tapered necks. Five-year freedom from type IA endoleak was similar between men and women (97% vs 96%; P = .38), as was freedom from type I/III endoleaks (91% vs 94%; P = .37) and reinterventions (91% vs 93%; P = .67). Five-year survival was 81% for female patients, similar to the 79% in male patients (P = .55), with one aneurysm-related death in female patients (0.4%) and five in male patients (0.8%; P = .76). Risk-adjusted analyses showed no association between sex and type IA endoleak (hazard ratio [HR], 1.4; 95% confidence interval [CI], 0.6-3.1; P = .41), type I/III endoleak (HR, 1.4; 95% CI, 0.7-2.8; P = .33), reintervention (HR, 1.0; 95% CI, 0.6-2.0; P = .77), and overall mortality (HR, 0.7; 95% CI, 0.4-1.1; P = .14). CONCLUSIONS Female patients undergoing EVAR with the Ovation platform presented with substantially more adverse proximal neck characteristics. Despite these differences, 5-year freedom from endoleaks and overall survival did not differ between sexes.
Collapse
Affiliation(s)
- Rens R B Varkevisser
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicholas J Swerdlow
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
| |
Collapse
|
8
|
The incidence and effect of noncylindrical neck morphology on outcomes after endovascular aortic aneurysm repair in the Global Registry for Endovascular Aortic Treatment. J Vasc Surg 2018; 68:1714-1724. [DOI: 10.1016/j.jvs.2018.03.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 03/09/2018] [Indexed: 11/20/2022]
|
9
|
Truong C, Kugler NW, Rossi PJ, Patel PJ, Hieb RA, Brown KR, Lewis BD, Seabrook G, Lee CJ. Sex-dependent outcomes following elective endovascular aortic repair. J Surg Res 2018; 229:177-185. [PMID: 29936987 DOI: 10.1016/j.jss.2018.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/01/2018] [Accepted: 03/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence has shown that women derive less benefit from endovascular aortic repair (EVAR) in large part due to more challenging aortoiliac anatomy. This study sought to examine whether sex-dependent outcomes exist following elective EVAR cases. METHODS An institutional retrospective review was performed on patients who underwent elective EVAR procedures between 2008 and 2014. Outcome data collected included procedural and hospital morbidity, mortality, and overall EVAR durability based on the incidence of unplanned graft-related secondary interventions (SIs) (e.g., open conversion, proximal or distal extensions, and coil embolizations). RESULTS One hundred eighty-one patients (150 men, 31 women) met the study inclusion criteria. Median follow-up was 40.3 mo. Women had more challenging anatomy compared to men including smaller overall iliac diameters (6.8 mm versus 8.0 mm, P < 0.001) and more severe iliac angulation (77% moderate to severe versus 44%, P < 0.001). Women had increased risk of postoperative complications compared to men (41.9% versus 11.3%, P = 0.003). There was no perioperative mortality in our series of elective EVAR cases. Median 5-y survival following EVAR was 64.4% for men and 76.3% for women (P = 0.599). Late SI rates following EVAR was 10.5% with 16 (10.7%) men and 3 (9.7%) women needing interventions (P = 0.870). Overall durability of EVAR extrapolated as time to SIs was 91% at 2 y and 85% at 5 y. Factors predisposing SIs were iliac tortuosity (P = 0.046), aortic neck angle (P = 0.022), and endoleak at the follow-up (P = 0.030). CONCLUSIONS In this study, immediate outcomes following EVAR were different between men and women, with women having increased rates of postoperative complications. Mortality and overall long-term durability of EVAR, however, were the same between sexes despite anatomical differences. EVAR durability was significantly dependent on the severity of iliac tortuosity, aortic neck angulation, and presence of endoleak at the follow-up.
Collapse
Affiliation(s)
- Connie Truong
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathan W Kugler
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter J Rossi
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parag J Patel
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert A Hieb
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kellie R Brown
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D Lewis
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gary Seabrook
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cheong J Lee
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| |
Collapse
|
10
|
Filis KA, Galyfos G, Sigala F, Tsioufis K, Tsagos I, Karantzikos G, Bakoyiannis C, Zografos G. Proximal Aortic Neck Progression: Before and After Abdominal Aortic Aneurysm Treatment. Front Surg 2017; 4:23. [PMID: 28523269 PMCID: PMC5415558 DOI: 10.3389/fsurg.2017.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022] Open
Abstract
Several risk factors including short or highly angulated proximal aortic neck have been associated with long-term outcomes after endovascular or open abdominal aortic aneurysm (AAA) repair. However, research data have emerged recently concerning the behavior of proximal aortic neck, and several authors have tried to evaluate this behavior after endovascular or open repair. Additionally, computed tomography angiography (CTA) remains the golden standard for detecting and observing the morphology of an AAA, both before and after treatment. Moreover, the question of whether the proximal neck’s progression independently affects postoperative morbidity and reintervention risks still remains. Therefore, this focused review aims to present all relevant data on the behavior of an AAAs neck, based on CTA imaging before and after repair, in order to produce useful conclusions for future clinical practice.
Collapse
Affiliation(s)
- Konstantinos A Filis
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Galyfos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiska Sigala
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Tsagos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Karantzikos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Bakoyiannis
- First Department of Surgery, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Zografos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
11
|
Machado R, Teixeira G, Oliveira P, Loureiro L, Pereira C, Almeida R. Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders? Braz J Cardiovasc Surg 2016; 31:232-238. [PMID: 27737406 PMCID: PMC5062709 DOI: 10.5935/1678-9741.20160047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/04/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION: Abdominal aortic aneurysm has a lower incidence in the female population, but
a higher complication rate. It was been hypothesized that some anatomical
differences of abdominal aortic aneurysm in women could be responsible for
that. We proposed to analyze our data to understand the differences in the
clinical and anatomical characteristics and the outcomes of patients
undergoing endovascular aneurysm repair, according to gender. METHODS: A retrospective analysis of patients undergoing endovascular aneurysm repair
between 2001-2013 was performed. Patients were divided according gender and
evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic
features, endograft type, anesthesic risk classification, length of stay,
reinterventions and mortality. Two statistical studies were performed, first
comparing women and men (Group A) and a second one comparing women and men,
adjusted by age (Group B). RESULTS: Of the 171 patients, only 5.8% (n=10) were females. Women were older
(P<0.05) and the number of women with no
atherosclerotic risk factor was significantly higher. The comparison
adjusted by age revealed women with statistically less smoking history, less
cerebrovascular disease and ischemic heart disease. Women had a trend to
more complex anatomy, with more iliac intern artery aneurysms, larger
aneurysm diameter and neck angulations statistically more elevated. No other
variables were statistically different between age groups, neither
reintervention nor mortality rates. CONCLUSION: Our study showed a clear difference in the clinical characteristics of women.
The female population was statistically older, and when compared with men
adjusted by age, had less atherosclerotic risk factors and less target organ
disease. Women showed a more complex anatomy but with the same outcomes.
Collapse
Affiliation(s)
- Rui Machado
- Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Gabriela Teixeira
- Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Pedro Oliveira
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Luís Loureiro
- Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Carlos Pereira
- Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Rui Almeida
- Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| |
Collapse
|