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Bai H, Kibrik P, Shaydakov ME, Singh M, Ting W. Indications, technical aspects, and outcomes of stent placement in chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2024; 12:101904. [PMID: 38759753 DOI: 10.1016/j.jvsv.2024.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Iliofemoral venous stent placement (IVS) has evolved to a well-established endovascular treatment modality for chronic iliofemoral venous obstruction (CIVO). Dedicated venous stents gained approval from the US Food and Drug Administration in 2019 and solidified IVS as a defined intervention with clear indications, contraindications, risks, benefits, and procedural management principles. This review focuses on the indications, technical aspects and outcomes of stenting for CIVO. Other aspects pertaining to IVS are covered in other articles that are a part of this series. METHODS This study conducted a literature search limited to English articles. Three search strategies were used, and references were managed in Covidence software. Four investigators screened and evaluated articles independently, excluding meta-analyses, clinical trial protocols, and nonrelevant studies. Eligible studies, focused on clinical outcomes and stent patencies, underwent thorough review. RESULTS The literature search yielded 1704 studies, with 147 meeting eligibility criteria after screening and evaluation. Exclusions were based on duplicates, irrelevant content, and noniliac vein stent placement. CONCLUSIONS Successful IVS for CIVO relies on meticulous patient selection, consistent use of intravascular ultrasound examination during procedures and attention to the technical details of IVS.
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Affiliation(s)
- Halbert Bai
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pavel Kibrik
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maxim E Shaydakov
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburg, PA
| | - Mandeep Singh
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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2
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Bakas JM, van Montfrans C, Moelker A, van den Bos RR, Malskat WSJ, Verhagen HJM, van Rijn MJE. Quality of Life after Venous Stenting for Post-thrombotic Syndrome and the Effect of Inflow Disease. Vasc Endovascular Surg 2024; 58:469-476. [PMID: 38156525 PMCID: PMC11095056 DOI: 10.1177/15385744231225802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Patients with PTS experience an impaired quality of life (QoL). We aimed to study QoL in patients stented for post thrombotic syndrome (PTS) and analyze the influence of different parameters. METHODS Patients stented for PTS after iliofemoral deep vein thrombosis were asked to complete the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) and the Short Form Health Survey (SF-36) in this cross-sectional study. All other data were collected retrospectively. Primary endpoints were median CIVIQ-20 and physical (PCS) and mental (MCS) component summary SF-36 scores. The influence of age, sex, and years between the procedure and completion of questionnaire were investigated using a multivariate linear regression model. Wilcoxon signed rank test compared the PCS and MCS with the normative. Effects of inflow from the deep femoral vein (DFV) and/or the femoral vein (FV) on QoL was analyzed in patients with patent stents. RESULTS The response rate was 70.3% (n = 45/64). Time period (median) from stenting to questionnaire completion was 6.6 years (IQR: 8.0). Most stents were placed unilateral left-sided (73.3%). For patients with patent stents (n = 42) median CIVIQ-20 was 35.5 (IQR: 17.3), higher than the minimum of 20.0 (P < .001). Median PCS of 44.7 (IQR: 14.2) was lower (P < .001), and MCS of 55.9 (IQR: 7.1) higher (P = .001) than the normative (50.0). Time since stenting and sex were not associated with QoL. Age was a significant predictor [standardized coefficient ß = .36, P = .04] for QoL using the CIVIQ-20, but not for the SF-36. Inflow disease did not impact QoL, but patients with occluded stents (n = 3) had poor functioning levels. CONCLUSION Quality of life is impaired after venous stenting for PTS, particularly physical functioning, among patients with an open stent, but was similar between patients with good and impaired inflow. Patients with a permanent stent occlusion had the lowest QoL.
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Affiliation(s)
- Jay M. Bakas
- Department of Vascular and Endovascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Wendy S. J. Malskat
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hence J. M. Verhagen
- Department of Vascular and Endovascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marie Josee E. van Rijn
- Department of Vascular and Endovascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
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3
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Sebastian T, Barco S, Voci D, Lichtenberg M, Schlager O, Jalaie H, de Graaf R, Erbel C, Massmann A, Schindewolf M, Spirk D. The TOPOS study. VASA 2024; 53:217-224. [PMID: 38525891 DOI: 10.1024/0301-1526/a001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Background: We aimed to study the long-term safety and efficacy of oblique venous stents for post-thrombotic syndrome (PTS) with iliac vein compression. Patients and methods: In the multinational, prospective, single-arm TOPOS study, PTS patients scheduled for endovascular therapy with the sinus-Obliquus® stent and optional distal extension with the sinus-Venous® or sinus-XL Flex® stent were enrolled at eight European vascular centres between October 2016 and December 2020. The primary outcome was primary stent patency at 24 months, and secondary outcomes included the clinical course of PTS (Villalta score, revised Venous Clinical Severity Score [rVCSS], Visual Analog Scale [VAS] of pain), quality of life changes (Chronic Venous Insufficiency Quality of Life Questionnaire, CIVIQ-20), and device-related complications. Results: We enrolled 60 patients (mean age 46±15 years, 68% women, 13% active ulcers): 80% required stent extension (70% below the inguinal ligament). The primary patency rate at 24 months was 80.7% (95%CI 68.1-90.0%); it was higher in patients without vs. those with stent extension (90.9% vs. 78.3%, p=.01). Compared to baseline, the Villalta, rVCSS, pain VAS, and CIVIQ-20 decreased by a median of 8 (interquartile range (IQR): 4-11), 5 (IQR: 3-7), 3 (IQR: 2-5), and 17 (IQR: 6-22) points, respectively; p<.001 for all parameters. Overall, 9 events of acute stent occlusion, 4 symptomatic stent stenosis, and 1 pulmonary embolism occurred. We did not observe major bleeding events or contralateral thrombosis. Conclusions: Endovascular treatment with the oblique stent and optional stent extension was safe and resulted in high patency rates at 24 months. The reduction in PTS severity was substantial and persisted over 2-year follow-up.
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Affiliation(s)
- Tim Sebastian
- Department of Angiology, University Hospital Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Switzerland
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany
| | - Davide Voci
- Department of Angiology, University Hospital Zurich, Switzerland
| | | | - Oliver Schlager
- Department of Medicine II, Division of Angiology, Medical University of Vienna, Austria
| | - Houman Jalaie
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Germany
| | - Rick de Graaf
- Department of Radiology, Interventional Radiology and Nuclear Medicine, Clinic of Friedrichshafen, Germany
| | - Christian Erbel
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Massmann
- Department of Radiology and Nuclear Medicine, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - David Spirk
- Institute of Pharmacology, University of Bern, Switzerland
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Pandey A, Schreiber C, Garton ALA, Jung B, Goldberg JL, Kocharian G, Carnevale JA, Boddu SR. Future Directions and Innovations in Venous Sinus Stenting. World Neurosurg 2024; 184:387-394. [PMID: 38590072 DOI: 10.1016/j.wneu.2023.12.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
This review explores the future role of venous sinus stenting (VSS) in the management of idiopathic intracranial hypertension and pulsatile tinnitus. Despite its favorable safety profile and clinical outcomes compared with traditional treatments, VSS is not yet the standard of care for these conditions, lacking high-level evidence data and guidelines for patient selection and indications. Current and recently completed clinical trials are expected to provide data to support the adoption of VSS as a primary treatment option. Additionally, VSS shows potential in treating other conditions, such as dural arteriovenous fistula and cerebral venous sinus thrombosis, and it is likely that the procedure will continue to see an expansion of its approved indications. The current lack of dedicated venous stenting technology is being addressed with promising advancements, which may improve procedural ease and patient outcomes. VSS also offers potential for expansion into modulation of brain electrophysiology via endovascular routes, offering exciting possibilities for neurodiagnostics and treatment of neurodegenerative disorders.
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Affiliation(s)
- Abhinav Pandey
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Craig Schreiber
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Andrew L A Garton
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Brandon Jung
- Human Health Major (BA), Emory University, Atlanta, Georgia, USA
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Gary Kocharian
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Srikanth R Boddu
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
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Snyder DJ, Zilinyi RS, Cohen DJ, Parikh SA, Sethi SS. Patient-Reported Outcomes in Venous Thromboembolism: A Systematic Review of the Literature, Current Challenges, and Ways Forward. J Am Heart Assoc 2023; 12:e032146. [PMID: 38014656 DOI: 10.1161/jaha.123.032146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) affects >1.2 million Americans annually. Although the clinical outcomes and economic burdens of VTE have been well described, the impact of VTE on patients' health status has yet to be summarized. This systematic review summarizes how patient-reported outcome measures (PROMs) have been used in VTE to date. METHODS AND RESULTS PubMed/MEDLINE was queried for literature published through March 2023 using PROMs in a population of patients with VTE. Studies were excluded if the reference was an editorial, review, or case report, or if the study included patients with conditions other than VTE. Qualitative analyses were performed. After screening and exclusion, 136 references were identified; 5 described PROM development, 20 focused on PROM validation, and 111 used PROMs in outcomes research. The most used generic PROMs were the 36-item Short-Form Health Survey and EuroQol 5-dimensional questionnaire, and the most common disease-specific PROMs were the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms and the Pulmonary Embolism Quality of Life Questionnaire. PROMs were used to quantify the changes in health status after diagnosis, characterize the trajectory of subsequent improvement, and identify drivers of continued impairments in health status like postthrombotic syndrome and postpulmonary embolism syndrome. PROMs were also used to investigate the impact of novel treatment modalities on quality of life. CONCLUSIONS This review demonstrates the many benefits of PROM use, including quantifying changes in health status with treatment, capturing patients' experiences with the treatment itself, and identifying complications of VTE. Incorporating PROMs into VTE care will be an essential component of evaluating the effectiveness of novel therapies and should lead to improved shared decision-making for patients with VTE.
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Affiliation(s)
- Daniel J Snyder
- Department of Medicine, New York Presbyterian Columbia University Irving Medical Center New York NY USA
| | - Robert S Zilinyi
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA
| | - David J Cohen
- Cardiovascular Research Foundation New York NY USA
- Saint Francis Hospital Roslyn NY USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA
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Sebastian T, Barco S, Lichtenberg M, Stahlhoff S, Schlager O, Jalaie H, de Graaf R, Erbel C, Massmann A, Schindewolf M, Kucher N. Twelve-month clinical outcomes of a hybrid oblique self-expanding nitinol stent used for the treatment of post-thrombotic syndrome with common iliac vein compression: The TOPOS study. Vasc Med 2021; 26:569-571. [PMID: 34130569 DOI: 10.1177/1358863x211017658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tim Sebastian
- Clinic of Angiology, University Hospital Zürich, Zürich, Switzerland
| | - Stefano Barco
- Clinic of Angiology, University Hospital Zürich, Zürich, Switzerland.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | | | - Stefan Stahlhoff
- Department of Angiology, Arnsberg Medical Center, Arnsberg, Germany
| | - Oliver Schlager
- Department of Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Houman Jalaie
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Rick de Graaf
- Department of Radiology, Interventional Radiology and Nuclear Medicine, Clinic of Friedrichshafen, Friedrichshafen, Germany
| | - Christian Erbel
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nils Kucher
- Clinic of Angiology, University Hospital Zürich, Zürich, Switzerland
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7
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Baccellieri D, Ardita V, Apruzzi L, Carta N, Bilman V, Melissano G, Chiesa R. Endovascular treatment of iliofemoral vein obstruction below the inguinal ligament using a new-dedicated stent: early experience from a single center. INT ANGIOL 2021; 40:187-195. [PMID: 33634688 DOI: 10.23736/s0392-9590.21.04589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to assess our experience with a new commercially available venous stent as an extension below the inguinal ligament in patients with iliofemoral venous outflow obstruction involving the common femoral vein. METHODS We treated 16 patients with iliofemoral venous outflow occlusion and post-thrombotic syndrome (PTS) (mean age: 52.5±20.2; female: 87.5%) with the Blueflow Venous Stent (plusmedica GmbH & Co. KG, Düsseldorf, Germany) between 2019 and 2020. All patients had unilateral venous disease with >50% stenosis in the iliofemoral veins. The primary endpoints assessed were technical success, primary and secondary patency rate at 1 year of follow-up, respectively. Clinical improvement was assessed with the Villalta Scale, revised venous clinical severity score (rVCSS) classification and visual analog-scale (VAS) respectively. RESULTS The technical success rate was 100%. No intraoperative and 30-days postoperative complications were documented. The primary and secondary patency rates were 80.2% and 100% respectively, at 1 year of follow-up. One in-stent occlusion and two in-stent restenosis were detected during follow-up. Stent fracture and/or migration were not observed during follow-up. A significant improvement in the Villalta Scale and rVCSS score was documented with a median score of 3 (IQR: 2-6) and 2.5 (IQR: 1-5) versus baseline at the last follow-up. A pain reduction of 18 mm on the VAS scale was documented at 1-year follow-up. CONCLUSIONS In this cohort of patients, the Blueflow Venous Stent across the inguinal ligament was safe and effective for the treatment of symptomatic iliofemoral venous disease, with a high primary patency rate at 1-year of follow-up. However, longer follow-up and larger cohorts are still needed.
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Affiliation(s)
- Domenico Baccellieri
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenzo Ardita
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
| | - Luca Apruzzi
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Niccolò Carta
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Victor Bilman
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Unit of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Sebastian T, Gnanapiragasam S, Spirk D, Engelberger RP, Moeri L, Lodigiani C, Kreuzpointner R, Barco S, Kucher N. Self-Expandable Nitinol Stents for the Treatment of Nonmalignant Deep Venous Obstruction. Circ Cardiovasc Interv 2020; 13:e009673. [PMID: 33272030 DOI: 10.1161/circinterventions.120.009673] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Angioplasty with stent placement is a therapeutic option for patients with acute thrombotic, postthrombotic, and nonthrombotic obstruction of the iliofemoral veins or inferior vena cava. Previous studies of steel-alloy stents described variable patency rate across indications. METHODS The prospective Swiss Venous Stent Registry includes patients treated with self-expandable nitinol stents for deep venous obstruction. Routine follow-up visits include serial duplex ultrasound for stent patency assessment. The primary outcome was primary stent patency. The secondary outcome was venous thromboembolisms. We studied the rate of stent occlusion and potentially contributing factors. RESULTS We included 379 patients: 160 with acute thrombotic, 193 with postthrombotic, and 26 with nonthrombotic deep vein obstruction. The mean age was 46±18 years; 55% were women. The cumulative 3-year primary patency rate was 80.5% (95% CI, 73.0%-88.0%) for acute thrombotic, 59.2% (95% CI, 50.4%-68.0%) for postthrombotic, and 100% for nonthrombotic obstruction (log-rank, P<0.0001). Annualized rates of stent occlusion or venous thromboembolism were 7.8 (acute thrombotic), 15.0 (postthrombotic), and 0 (nonthrombotic) events/100 patient-years. In a multivariable Cox regression model, postthrombotic femoral veins at baseline (hazard ratio, 2.64 [95% CI, 1.53-4.56]) and the number of stents (hazard ratio, 1.22 [95% CI, 1.06-1.40]) were associated with stent occlusion after conditioning for age, sex, and clinically relevant factors. CONCLUSIONS The rate of stent occlusion (patency loss) and venous thromboembolism varies substantially across indications, also with dedicated venous nitinol stents. Patients with postthrombotic femoral veins and those who received multiple stents were characterized by the highest risk. Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT02433054.
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Affiliation(s)
- Tim Sebastian
- Clinic for Angiology, University Hospital Zurich, Switzerland (T.S., S.G., L.M., R.K., S.B., N.K.)
| | - Suvetha Gnanapiragasam
- Clinic for Angiology, University Hospital Zurich, Switzerland (T.S., S.G., L.M., R.K., S.B., N.K.).,Medical Faculty, University of Zurich, Switzerland (S.G., L.M.)
| | - David Spirk
- Institute of Pharmacology, University of Bern, Switzerland (D.S.)
| | | | - Laura Moeri
- Clinic for Angiology, University Hospital Zurich, Switzerland (T.S., S.G., L.M., R.K., S.B., N.K.).,Medical Faculty, University of Zurich, Switzerland (S.G., L.M.)
| | - Corrado Lodigiani
- Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy (C.L.)
| | - Robert Kreuzpointner
- Clinic for Angiology, University Hospital Zurich, Switzerland (T.S., S.G., L.M., R.K., S.B., N.K.)
| | - Stefano Barco
- Clinic for Angiology, University Hospital Zurich, Switzerland (T.S., S.G., L.M., R.K., S.B., N.K.)
| | - Nils Kucher
- Clinic for Angiology, University Hospital Zurich, Switzerland (T.S., S.G., L.M., R.K., S.B., N.K.)
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