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Chen LWY, Chang TNJ, Lee CP, Sung CWH, Cheng C, Chang KH, Chao YK. Robotic sympathetic trunk reconstruction for compensatory sweating after thoracic sympathectomy. JTCVS Tech 2023; 21:251-258. [PMID: 37854845 PMCID: PMC10579868 DOI: 10.1016/j.xjtc.2023.05.022] [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: 03/13/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 10/20/2023] Open
Abstract
Objectives Endoscopic thoracic sympathectomy may be complicated by the onset of disabling compensatory sweating (CS). The objective of this case series is to report the 2-year outcomes after robotic sympathetic trunk reconstruction (STR) for the reversal of CS in patients who had undergone endoscopic thoracic sympathectomy. Methods We prospectively followed-up a total of 23 patients who had undergone robotic STR because of intolerable CS between October 2017 and January 2021. A visual analog scale ranging from 0 to 10 (with 10 indicating the highest degree) was used to assess the severity of CS at different anatomical locations, thermoregulatory alterations, and gustatory hyperhidrosis. Measurements were performed before STR and at 6-month and 2-year follow-up. Results The mean age of the study participants was 43.3 ± 7.8 years, and 20 (87%) were men. The reversal procedure was performed after a mean of 19.6 ± 7.8 years from endoscopic thoracic sympathectomy. In all patients, nerve defects were successfully bridged using sural nerves (mean length, 9.7 cm on the right and 9.8 cm on the left). No cases of Horner syndrome were noted. At 6 postoperative months, the severity of CS decreased significantly at all body surface areas. The observed improvements were effectively maintained at 24 post-STR months. There was no evidence of either recurrent hyperhidrosis at the primary site or transition of CS to other anatomical locations. Similar improvements were evident for thermoregulatory alterations and gustatory hyperhidrosis. Conclusions Robotic STR is safe and effective in reversing intolerable CS after endoscopic thoracic sympathectomy.
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Affiliation(s)
- Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Pang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Cheyenne Wei-Hsuan Sung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuan Cheng
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hemead HM, Etman W, Hemead S, Elrewany E, Abdelaziz A. Patients' satisfaction after bilateral thoracoscopic sympathicolysis. J Minim Access Surg 2023; 19:478-481. [PMID: 36695242 PMCID: PMC10695304 DOI: 10.4103/jmas.jmas_179_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 01/22/2023] Open
Abstract
Background Palmar hyperhidrosis is a distressing condition implicating individuals' social life and self-esteem. Surgery has proven to be highly effective with excellent safety profile. However, compensatory hyperhidrosis (CH), a relatively common adverse event of the procedure, is sometimes problematic in a few patients. Patients and Methods A questionnaire, including Hyperhidrosis Disease Severity Scale (HDSS), was designed to assess the overall satisfaction of patients who underwent bilateral endoscopic thoracic sympathectomy between November 2018 and July 2021. They were requested to respond to the questionnaire before surgery and during the follow-up visits. Results Sixty-three patients were recruited, 37 males and 26 females. The age of the participants ranged from 6 to 27 years (mean 17.05 ± 5.55 years). Most patients reported a positive impact on their professional and social life. Two patients experienced significant compensatory hyperhydrosis impacting their daily life. There was a significant improvement of the HDSS score after surgery. Around 95.2% of the participants (n = 60) had three-point improvement indicating 80% reduction of sweat production. Conclusion : Bilateral endoscopic thoracoscopic sympathectomy has shown a high success rate with low adverse events. CH, however, remains a significant cause of morbidity in few patients. Therefore, continuous evaluation of patients' satisfaction is of utmost importance to help improve our understanding to risk factors and prevalence of CH, improve our techniques to minimise its occurrence and treat patients with distressing symptoms. These data will guide surgeons when counselling patients to make insightful decisions based on the benefits and risks of the procedure.
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Affiliation(s)
- Hanan M. Hemead
- Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Egypt
| | - Waheed Etman
- Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Egypt
| | - Sarah Hemead
- Faculty of Medicine, Alexandria University, Egypt
| | - Ehab Elrewany
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Egypt
| | - Ahmed Abdelaziz
- Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Egypt
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Loizzi D, Mongiello D, Bevilacqua MT, Raveglia F, Fiorelli A, Congedo MT, Ardò NP, Sollitto F. Surgical management of compensatory sweating: A systematic review. Front Surg 2023; 10:1160827. [PMID: 37035574 PMCID: PMC10073509 DOI: 10.3389/fsurg.2023.1160827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Endoscopic thoracic sympathectomy (ETS) surgery is a highly effective treatment of primary hyperhidrosis (PH) for the palms, face, axillae. Compensatory sweating (CS) is the most common and feared side effect of thoracic sympathectomy. CS is a phenomenon characterized by increased sweating in sites distal to the level of sympathectomy. Compensatory sweating is the main problem for which many patients give up surgery, losing the chance to solve their problem and accepting a poor quality of life. There are still no treatments that offer reliable solutions for compensatory sweating. The treatments proposed in the literature are scarce, with low case histories, and with uncertain results. Factors associated with CS are extension of manipulation of the sympathetic chain, level of sympathetic denervation, and body mass index. Therapeutic options include non surgical treatment and surgical treatment. Non surgical treatments include topical agents, botulinum toxin, systemic anticholinergics, iontophoresis. Surgical treatments include clip removal, extended sympathectomy and sympathetic chain reconstruction, although the efficacy is not well-established for all the methods. In this review we provide an overview of the treatments and outcomes described in the literature for the management of compensatory CS, with focus on surgical treatment.
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Affiliation(s)
- Domenico Loizzi
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
- Correspondence: Domenico Loizzi
| | - Diletta Mongiello
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | | | | | - Alfonso Fiorelli
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Teresa Congedo
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Nicoletta Pia Ardò
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Francesco Sollitto
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
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Long-term Outcomes of Endoscopic Thoracoscopic Sympathectomy for Primary Focal Palmar Hyperhidrosis: High Patient Satisfaction Rates Despite Significant Compensatory Hyperhidrosis. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:730-735. [PMID: 36130719 DOI: 10.1097/sle.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Endoscopic thoracoscopic sympathectomy (ETS) is the gold standard therapy for primary focal palmar hyperhidrosis (PFPH), resulting in high patient satisfaction rates. The most common side effect of ETS is compensatory hyperhidrosis (CH). Previous studies followed patients' satisfaction degree of surgery and the incidence of CH during a limited follow-up period of 1 to 3 years. The purpose of this study was to investigate the long-term outcomes and patient satisfaction after ETS. MATERIALS AND METHODS After approval of our institutional review board, we conducted a retrospective review of all consecutive patients who underwent ETS for PFPH at our institution between 1998 and 2019. Electronic medical records were reviewed for short-term outcomes. Long-term outcomes were collected through telephone questionnaires. Primary outcome was the resolution of PFPH. Secondary outcomes were CH and long-term patient satisfaction. RESULTS During the study period, 256 patients underwent ETS to treat primary focal palmar hyperhidrosis at our institution between the years 1998-2019. One-hundred and fifty (58.6%) patients agreed to participate in the study and were included in the final analysis. The mean age was 23.8 (17 to 58) years, 56% were females. The mean follow-up time was 11±6.1 (1 to 22) years. Ninety-four percent reported resolution of PFPH; however, CH was reported by 90% of participants. CH decreased mean patient satisfaction score from 4.8±0.5 to 3.8±2 (P=0.009). This effect was more pronounced in patients with CH of the head and neck (P=0.009). Patients' satisfaction decreased over time from a mean of 4.8±0.4 in the first year after surgery to a mean of 3.7±1.4 12 years or more after surgery (P <0.001). Despite this, 79% of patients reported they would recommend ETS to other patients. CONCLUSIONS ETS for PFPH is highly effective and results in high patient satisfaction rates even after long-term follow-up. Despite high rates of postoperative CH, nearly 80% of patients would still recommend the procedure to fellow patients, justifying its reputation as the gold standard treatment for PFPH.
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Park JK, Hyun K, Moon MH, Lee J. Surgical treatment of facial blushing: Patient selection and operative technique (retrospective observational study). Medicine (Baltimore) 2022; 101:e29808. [PMID: 35801793 PMCID: PMC9259148 DOI: 10.1097/md.0000000000029808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Surgeons are often reluctant to offer further intervention to patients with medically intractable facial blushing. This is mainly because of the relatively high failure rate of blushing resolution and a high incidence of compensatory hyperhidrosis. In this study, we sought to identify the type of blushing that would benefit from surgery and minimize compensatory hyperhidrosis by applying diffuse sympathicotomy (DS). This study was a retrospective review of 62 patients who underwent R2 endoscopic thoracic sympathicotomy (ETS) and preemptive DS for facial blushing. Facial blushing was classified as autonomic-mediated blushing (thermoregulatory, emotional) and vasodilator-mediated blushing (constant) based on the history and precipitating factors for blushing. DS was performed at lower-thoracic levels in the form of limited DS (right R5/7/9/11, left R5/6/8/10) or extended DS (bilateral R5-11). Resolution of blushing (described as "almost disappeared") was achieved in 48% of patients with a median follow-up of 19.6 months. There was a significant difference in resolution among 3 types of blushing (emotional: 55%, thermoregulatory: 28%, constant: 15%, P = .03). Multivariate analysis confirmed thermoregulatory and constant type blushing as a potential independent predictor of blushing resolution. Even though there was no difference between the DS procedures with respect to compensatory hyperhidrosis, intolerable compensatory hyperhidrosis (Hyperhidrosis Disease Severity Scale = 4) occurred in only 11% of patients. DS redistributed sweating area, being predominantly on the chest and mid-back (89%), also seen on the abdomen-waist-groin-buttocks-thighs (63%). Overall, 77% of patients experienced satisfactory results. Emotional blushing proved to be an established indication of ETS where good long-term results can be expected. Expansion of surgical indication to thermoregulatory or constant type blushing needs to be validated in future studies. Additionally, compensatory hyperhidrosis, another hurdle for ETS, can be minimized by preemptive DS, resulting in redistribution and decrease of sweating.
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Affiliation(s)
- Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
- *Correspondence: Kwanyong Hyun, Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, South Korea (e-mail: )
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Jungsun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
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Carvalho C, Marinho AS, Barbosa-Sequeira J, Correia MR, Banquart-Leitão J, Carvalho F. Compensatory sweating after thoracoscopic sympathectomy for primary focal hyperhidrosis in children: Are there patient-related risk factors? J Pediatr Surg 2022; 57:203-206. [PMID: 34815104 DOI: 10.1016/j.jpedsurg.2021.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Compensatory sweating (CS) is a common complication after thoracoscopic sympathectomy (TS) and is mainly associated with surgical technique. Our aim was to identify potential risk-factors for CS following TS for primary focal hyperhidrosis in children. METHODS A retrospective, single-center review of all bilateral TS was performed between 2017 and 2019. Hyperhidrosis disease severity scale was used for pre-operative severity assessment. Post-operative evaluations were performed after three and six months. RESULTS More than the 36-month period, 41 patients were submitted to T2-T4 TS, and 25 were females (60.9%). Median age at surgery was 15.5 years. CS was identified at the 3rd month in 17 (41%) children with most in the dorsolumbar region (56%). By the 6th month, there was a significant reduction in CS (41 to 32%, p = 0.02). The probability of resolution of CS by 6 months is about 50% in both the dorsolumbar and abdominal regions. Neither age, gender, body mass index, family history, or concomitant illnesses seemed to influence CS (p > 0.05). Axillary hyperhidrosis appears to be associated with the development of dorsolumbar CS (p = 0.037). CONCLUSION Thoracoscopic sympathectomy for PFH is a safe and effective procedure, but compensatory sweating can be a common and debilitating side effect. Age, gender, and body mass index do not appear to influence CS. Axillary hyperhidrosis may be related to the development of dorsolumbar CS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Catarina Carvalho
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal.
| | - Ana Sofia Marinho
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - Joana Barbosa-Sequeira
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - Mário Rui Correia
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - José Banquart-Leitão
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - Fátima Carvalho
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
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Raveglia F, Orlandi R, Guttadauro A, Cioffi U, Cardillo G, Cioffi G, Scarci M. How to Prevent, Reduce, and Treat Severe Post Sympathetic Chain Compensatory Hyperhidrosis: 2021 State of the Art. Front Surg 2022; 8:814916. [PMID: 35047551 PMCID: PMC8763307 DOI: 10.3389/fsurg.2021.814916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
The role of thoracic surgery in the management of hyperhidrosis is well-known and thoracoscopic sympathetic interruption is commonly accepted as being the most effective treatment. However, some concerns still remain regarding the potential to develop compensatory hyperidrosis (CH), the most troublesome and frequent side effect after surgery and its management. Compensatory hyperidrosis prevention may be achieved by identifying subjects at higher risk and/or targeting nerve interruption level on the base of single patient characteristics gathered during the preoperative survey. Furthermore, the surgical treatment may consist of different techniques aimed at reversing the effects of previous sympathetic interruption. To predict CH after sympathectomy, the most interesting proposals in recent literature are a temporary thoracoscopic sympathetic block and the introduction of new and targeted preoperative surveys. If the role of nerve clipping technique vs. the definitive cutting is still intensely under debated, new approaches have been recently proposed to reduce the incidence of CH. In particular, extended sympathicotomy has been described as an alternative to overcome severe forms. Last, among the techniques developed to reverse sympathetic interruption effect, diffuse sympathicotomy (DS) and microsurgical sympathetic trunk reconstruction represent advances in this field. An all-round review of these topics is strongly needed. Our aim is to cover all the above issues point by point. Although sympathectomy represents a small part of thoracic surgery, we believe that it is worthy of interest because of the profound effect that complications for a benign condition can have on patients.
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Affiliation(s)
- Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
- *Correspondence: Federico Raveglia
| | - Riccardo Orlandi
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, Istituti Clinici Zucchi Monza, University of Milano-Bicocca, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Roman, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
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Andresen JR, Scheer F, Schlöricke E, Sallakhi A, Liedke MO, Andresen R. CT-guided thoracic sympathicolysis versus VATS sympathectomy in the therapeutic concept for severe primary palmar Hyperhidrosis. Thorac Cardiovasc Surg 2021; 70:152-158. [PMID: 33860510 DOI: 10.1055/s-0041-1725205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome. MATERIALS AND METHODS In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred. RESULTS Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients. CONCLUSION For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.
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Affiliation(s)
| | - Fabian Scheer
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - Eric Schlöricke
- Department of Visceral, Thoracic and Vascular Surgery, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - Aria Sallakhi
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Marc Olaf Liedke
- Department of Visceral, Thoracic and Vascular Surgery, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
| | - Reimer Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
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