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Soares RDA, Amaro K, Nasser AI, Cury MVM, Nakamura ET, Pedrosa KDL, Sacilotto R. Endovascular repair for infra-renal aortic aneurysms with supra-renal fixation endoprosthesis: Results and outcomes. Vascular 2024:17085381241264381. [PMID: 39030072 DOI: 10.1177/17085381241264381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
OBJECTIVE The main objective of this paper is to evaluate the outcomes regarding endoleaks, reinterventions, and death related to aneurysm complications in patients submitted to endovascular repair (EVAR) for abdominal aortoiliac aneurysm (AAA) using Endurant II (Medtronic) and Zenith Flex (Cook) endografts. METHODS This was a prospective, consecutive cohort study of patients with AAA who underwent EVAR with the use of Endurant II stent graft and Zenith Flex endograft. RESULTS A total of 156 patients submitted to EVAR were evaluated. The perioperative mortality was 5.1%, 8 patients. The median clinical follow-up period was 760 ± 80 days. There were 28 patients (17.9%) submitted to urgent repair of the aneurysm (symptomatic expansion or rupture) and 128 patients (82.1%) submitted to elective repair. There were 36 cases (23.1%) of later endoleak and most of them are Type II endoleaks (21 patients, 13.4%). There were 12 cases of Type I endoleak. Moreover, regarding limb graft occlusion (LGO), there were 9 patients (5.8%). The overall survival rate in Kaplan-Meier analysis at 720 days was 84.8% in the total cohort. The freedom from reintervention rate in Kaplan-Meier analysis at 720 days was 92.7% in the total cohort. The linear regression analysis for survival rates showed that chronic kidney disease (p = .03; hazard ratio (HR) = 2.82, CI = 1.07-4.44) was the only factor related to poorer survival rates in both univariate and multivariate analyses. The linear regression analysis showed that the presence of endoleaks (p < .001, HR = 6.69, CI = 2.26-8.48) and limb graft occlusion (p < .001, HR = 8.02, CI = 1.60-9.99) were related to reintervention in both univariate and multivariate analyses. CONCLUSION In this present study, supra-renal fixation endograft devices were safe and efficient in treating AAA, with satisfactory results and no renal compromise. The linear regression analysis showed that the presence of endoleaks and limb graft occlusion were related to higher reintervention rates in both univariate and multivariate analyses.
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Affiliation(s)
- Rafael de Athayde Soares
- Division of Vascular and Endovascular Surgery, Hospital Do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | - Kaline Amaro
- Division of Vascular and Endovascular Surgery, Hospital Do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | - Ana Isabel Nasser
- Division of Vascular and Endovascular Surgery, Hospital Do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | - Marcus Vinícius Martins Cury
- Division of Vascular and Endovascular Surgery, Hospital Do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | - Edson Takamitsu Nakamura
- Division of Vascular and Endovascular Surgery, Hospital Do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | - Keityane de Lima Pedrosa
- Division of Vascular and Endovascular Surgery, Hospital Do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | - Roberto Sacilotto
- Division of Vascular and Endovascular Surgery, Hospital Do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
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Yazar O, Willems S, Zonnebeld N, Salemans PB, Wong CY, Bouwman LH. Single centre mid-term experience with E-liac branched device from Artivion®. Ann Vasc Surg 2024:S0890-5096(24)00441-2. [PMID: 39029895 DOI: 10.1016/j.avsg.2024.05.042] [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: 01/08/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION The use of iliac branch device (IBD) is increasing due to the less invasive character and accumulated experience of physicians in this endovascular technique. Clinical data regarding the E-liac stent graft from Artivion®, however, are scarce. This study shows the mid-term outcomes of the E-liac stent graft from a large single centre. METHODS Patients treated with IBD for (aorto-)iliac aneurysms between September 2015 and December 2022 with follow-up in our centre were included. (Post)operative (technical success, reintervention, 30-day mortality) and mid-term outcomes (endoleak, reintervention, hypogastric patency, mortality) were analysed. RESULTS Sixty-three patients (60 male, median age 70 years (IQR 66-;76)) were treated with 82 E-liac stent grafts for aorto-iliac aneurysms with a median follow-up of 38 months (IQR 22-51). The technical success rate was 95%. 97.6% of the interal iliac arteries remained patent during follow-up. No 30-day mortality was encountered. During follow-up one patient had an endoleak type 1b of both hypogastric arteries, however the patient refused additional interventions. One other patient had a type 2 endoleak with contained rupture. Paliative treatment was chosen because of the patient's severe comorbidities. One (1.6%) IBD-related reintervention was performed with relining of the stent graft. Secondary patency of the interal iliac artery was 95.1% and the mortality was 25.4% during follow-up. CONCLUSIONS This study shows high technical success rates for the E-liac stent graft, with corresponding good mid-term outcomes. The E-liac stent graft is a feasible, safe and effective stent graft in the treatment of aorto-iliac aneurysms.
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Affiliation(s)
- Ozan Yazar
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, the Netherlands.
| | - Stefanie Willems
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Niek Zonnebeld
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Pieter B Salemans
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Chun-Yu Wong
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Lee H Bouwman
- Department of Vascular and Endovascular Surgery, Zuyderland Medical Center, Heerlen, the Netherlands; Faculty of Science and Engineering, Maastricht University, The Netherlands
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de Athayde Soares R, Campos ABC, Figueiredo PWS, Vaz JHLG, Brienze CS, Waisberg J, Sacilotto R. The Importance of the Hypogastric Artery Preservation during Treatment for Aortoiliac Aneurysms: A Prospective Single-Center Study. Ann Vasc Surg 2023; 92:201-210. [PMID: 36690249 DOI: 10.1016/j.avsg.2022.12.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/27/2022] [Accepted: 12/12/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND To determine the importance of the hypogastric artery for the outcomes of survival, endoleaks, reinterventions, buttock claudication (BC), and perioperative mortality rate (PMR) in patients with aortoiliac aneurysms (AIA) receiving endovascular or open surgical (OS) repair. METHODS This was a prospective consecutive cohort study of patients with AIA who underwent endovascular treatment or OS repair during the period of 2010-2021. Endovascular repair was performed with use of aortoiliac endoprosthesis associated with internal iliac artery (IIA) coil embolization and/or with iliac branch endoprosthesis (IBE) in order to preserve the IIA. The AIA OS repairs were performed with the artery ligation in order to exclude the IIA, or in some cases, the exclusion of the IIA was performed with an endosuture in the proximal stump of the artery. Three groups were identified in the postprocedural period: group 0 (no hypogastric arteries (HAs) preserved), group 1 (1 hypogastric artery preserved), and group 2 (2 hypogastric arteries preserved). RESULTS A total of 91 patients were submitted to OS or endovascular surgery. Regarding the HA patency, there were 17 patients in group 0, 45 patients in group 1, and 29 patients in group 2. There were 17 cases of bowel ischemia (BI) (94.1% in group 0, 5.9% in group 1, and no cases in group 2, P < 0.001) most of them in group 0, with statistical significance, 12 cases of BC (91.7% in group 0, 8.3% in group 1, and no cases in group 2, P < 0.001), most of them in group 0, with statistical significance. The perioperative mortality was 14.3%, 13 patients (9 patients - 52.9% group 0, 3 patients - 6.7% group 1, and 1 patient - 3.4% group 2, P < 0.001). The linear regression analysis for survival rates showed that BI [P = 0.026 to hazard ratio (HR) = 1.69], emergency aortoiliac repair (P < 0.001, HR = 8.86), and number of HAs (P < 0.001, HR = 5.46) in postoperative were related to poorer survival rates in both univariate and multivariate analysis. The linear regression analysis showed that the number of HAs (P < 0.001, HR = 3.61) in postoperative, emergency aortoiliac repair (P = 0.002, HR 3.233), and cardiac disease (P = 0.048, HR = 3.84) were related to BI. CONCLUSIONS In conclusion, the number of HA is crucial for adequate and safe outcomes after abdominal aortic aneurysm (AAA) repair. The main factors related to death were BI, emergency aortoiliac repair, and the number of HAs preserved. Moreover, the main factors related to BI were the number of HAs in postoperative, emergency aortoiliac repair, and cardiac disease.
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Affiliation(s)
- Rafael de Athayde Soares
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
| | - Ana Beatriz Campelo Campos
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | | | - Carolina Sabadoto Brienze
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Jaques Waisberg
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Roberto Sacilotto
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
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Ye K, Qiu P, Qin J, Peng Z, Li W, Yin M, Lu X. Internal iliac artery preservation during endovascular aortic repair using in situ laser fenestration. J Vasc Surg 2023; 77:129-135. [PMID: 35944730 DOI: 10.1016/j.jvs.2022.07.174] [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: 05/13/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the technical and short-term clinical outcomes of internal iliac artery (IIA) reconstruction during endovascular aortic repair (EVAR) with in situ laser-assisted fenestration in cases of abdominal aortic aneurysm (AAA) in which the iliac artery is unfit for an internal branched device (IBD). METHODS In the present single-institution retrospective study, we analyzed patients with AAAs who had undergone EVAR with in situ laser-assisted fenestration for IIA reconstruction between January 2018 and April 2021. The study included patients with iliac artery anatomy unfit for the use of commercial IBDs. The primary safety end point was freedom from major adverse events and unplanned reinterventions within 30 days. The primary efficacy end point was freedom from IIA restenosis, reintervention, and symptoms due to pelvic ischemia at 1 year after the procedure. RESULTS A total of 20 patients requiring IIA reconstruction but with anatomy unfit for IBD placement were treated with in situ laser-assisted fenestration during EVAR for aortoiliac aneurysms during the study period. The mean age of our patients was 72 years, and 90% were men. The technical success rate was 100%. No patient had died within 30 days after the procedure. A suspicious IIA perforation had occurred in one patient, which was treated with an additional covered stent, for a primary safety end point of 95.0%. After a mean follow-up of 11 months, all except for one of the reconstructed IIAs were patent. Three patients reported symptoms of buttock claudication on the IIA occluded side at their 3-month follow-up after the procedure. However, these symptoms had subsided in two of these patients at 6 months. Type II endoleaks without sac expansion had occurred in two patients owing to retrograde blood flow from the inferior mesenteric artery and lumbar artery. Both patients were kept under close surveillance. The rate of freedom from major adverse events and unplanned reinterventions within 30 days (primary efficacy end point) was 86.3% at 1 year after procedure. CONCLUSIONS In situ laser-assisted fenestration was found to be a safe and effective alternative method for IIA reconstruction during EVAR for aortoiliac aneurysms in patients with anatomy unfit for IBD.
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Affiliation(s)
- Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China.
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Yang SS, Kim HK, Kim JY, Lee T, Lee SS, Park HS, Park SC, Park YJ. Preliminary outcomes of the LifeStream balloon-expandable stentgraft in Zenith Iliac branch device to preserve pelvic circulation: A Korean multicenter study. Asian J Surg 2023; 46:94-98. [PMID: 35123861 DOI: 10.1016/j.asjsur.2022.01.012] [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: 10/03/2021] [Revised: 01/01/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To evaluate early outcomes of aortoiliac or isolated iliac artery aneurysm repair using the Zenith® Bifurcated Iliac Side (ZBIS) stent graft combined with the LifeStream™ Balloon Expandable Vascular Covered Stent as a bridging stentgraft. METHODS Between August 2018 and February 2020, 38 patients (37 male, mean age 72.7 years) received 46 LifeStream stents in conjunction with 38 ZBIS stent grafts to bridge hypogastric arteries for aneurysm repair in six university hospitals in Korea. The primary outcomes were technical success rate and procedure-related complications. Secondary outcomes were bridging stent graft patency and re-intervention. RESULTS All procedures were performed as elective standard endovascular aortic aneurysm repair (EVAR) and unilateral iliac branch device (IBD). Mean follow-up was 13.1 months, and patient overall survival rate was 96.7%. Technical success rate was 76.3% (n = 29). Causes of failure included seven total endoleaks; six type Ic and one type IIIc from the IBD junction, one unintentional IIA coverage, and one failure to deploy the IIA stent graft. Procedure-related complications occurred in two patients: one LifeStream migration and one ZBIS stent graft migration. Overall patency rates for the LifeStream and ZBIS stents were 97.4% and 97.2%, respectively. CONCLUSION This multicenter preliminary experience with the LifeStream™ Balloon Expandable Vascular Covered Stent in IBD demonstrated good patency; however, an unexpectedly high rate of type Ic endoleaks was observed. Combined use of the LifeStream stent with the ZBIS stent graft is safe and feasible to preserve pelvic circulation with good patency and a low rate of device-related reintervention.
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Affiliation(s)
- Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Taeseung Lee
- Division of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Su Lee
- Division of Vascular and EndoVascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hyung Sub Park
- Division of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Borzsák S, Süvegh A, Szentiványi A, Fontanini DM, Vecsey-Nagy M, Banga P, Sótonyi P, Szeberin Z, Csobay-Novák C. Midterm Results of Iliac Branch Devices in a Newly Established Aortic Center. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081154. [PMID: 36013332 PMCID: PMC9409818 DOI: 10.3390/life12081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022]
Abstract
The first-line treatment of common iliac artery aneurysms is endovascular repair. International guidelines recommend the preservation of the internal iliac artery, which is best achieved by the implantation of an iliac bifurcation device (IBD). Our aim was to evaluate the initial midterm results of IBDs in the leading vascular center of Hungary. In this single-center retrospective study, relevant clinical data and the results of the imaging examinations were collected and analyzed in all patients who underwent IBD implantation between December 2010 and July 2021. Thirty-five patients (31 males, mean age: 67.9 ± 8.5 years) underwent endovascular treatment with 37 IBD implantations. Technical success was achieved in 88.2% of the patients, with no perioperative mortality or open surgical conversion. One patient was lost during follow-up. Internal iliac artery occlusion was detected in three (8.8%) patients, and reintervention was performed in five (14.7%) patients. Primary patency of the internal iliac branch was 97.1% at 1 month, 93% at 2 months, and 89.0% at 5 years. The average follow-up time was 20.1 ± 26.2 months, during which two (5.9%) deaths occurred. Our initial experience with iliac branch devices was associated with a low complication rate and a favorable outcome, which confirms the midterm success of this intervention.
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Affiliation(s)
- Sarolta Borzsák
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
| | - András Süvegh
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
| | - András Szentiványi
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
| | - Daniele Mariastefano Fontanini
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
| | - Milán Vecsey-Nagy
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
| | - Péter Banga
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Department of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, Hungary
| | - Péter Sótonyi
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Department of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, Hungary
| | - Zoltán Szeberin
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Department of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Correspondence: ; Tel.: +36-1-458-6870
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Kouvelos G, Nana P, Spanos K. Commentary: Time to Preserve the Iliac Arteries During EVAR. J Endovasc Ther 2020; 27:826-827. [PMID: 32638631 DOI: 10.1177/1526602820940784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- George Kouvelos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Petroula Nana
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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