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Dreksler H, Nagpal SK, Hajjar G, Roberts DJ. Successful surgical management of a suspected high-flow inferior mesenteric artery aneurysm in a patient with chronic celiac and superior mesenteric artery occlusions. J Vasc Surg Cases Innov Tech 2024; 10:101438. [PMID: 38445064 PMCID: PMC10912906 DOI: 10.1016/j.jvscit.2024.101438] [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: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 03/07/2024] Open
Abstract
Inferior mesenteric artery (IMA) aneurysms account for approximately 1% of visceral artery aneurysms and can occur secondary to high flow because of occlusive disease in other mesenteric arteries. We describe the case of a 79-year-old man who presented with a 3.3-cm IMA aneurysm and chronic total occlusions of the celiac artery and superior mesenteric artery (SMA). After an unsuccessful attempt at endovascular SMA recanalization, he underwent an uncomplicated retrograde aorta to SMA bypass and antegrade aorta to IMA bypass. We propose that an aorta to IMA bypass after SMA revascularization is safe and effective to treat suspected high-flow IMA aneurysms.
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Affiliation(s)
- Hannah Dreksler
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sudhir K. Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - George Hajjar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Derek J. Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Khatri S, Parikh R, Smith M, Friedman J. Endovascular management of colic artery pseudoaneurysm: A case report of successful intervention in a 59-year-old male with abdominal hematoma. Radiol Case Rep 2024; 19:449-454. [PMID: 38046917 PMCID: PMC10692486 DOI: 10.1016/j.radcr.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Visceral artery pseudoaneurysms, including inferior mesenteric artery pseudoaneurysms, are rare, occurring at an estimated incidence of 0.01%-0.2%. The literature reports only around 60 cases of inferior mesenteric pseudoaneurysm to date. The management of this condition lacks a consensus; nevertheless, coil embolization remains the preferred approach for stable patients. Here, we present a unique clinical scenario involving a 59-year-old male who underwent exploratory laparotomy for a retroperitoneal hematoma. Subsequently, he was diagnosed with an inferior mesenteric pseudoaneurysm, specifically affecting the left colic artery, and successfully managed using coil embolization.
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Affiliation(s)
| | | | - Matthew Smith
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
| | - Joseph Friedman
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
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3
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Dubois AS, Mathew JM, Makris SA, Renwick B. Surgical Excision of a Contained Rupture of an Inferior Mesenteric Aneurysm. Vasc Endovascular Surg 2022; 56:321-324. [PMID: 34983268 DOI: 10.1177/15385744211069746] [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: 11/16/2022]
Abstract
Inferior mesenteric artery (IMA) aneurysms represent the minority of visceral aneurysm presentations. A 57-year-old female was admitted with a symptomatic IMA aneurysm secondary to atherosclerotic disease. She was treated with open excision which revealed a contained ruptured of a true aneurysm. This case highlights the challenges of an accurate preoperative diagnosis of IMA aneurysm and the correct position of the recent guidelines on visceral aneurysms issued by the Society of Vascular Surgery (SVS).
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Affiliation(s)
- Andre S Dubois
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Joyce M Mathew
- Department of Histopathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sotirios A Makris
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Bryce Renwick
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
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Yamashita Y, Nakagawa S, Sakamoto K, Kitamoto S, Horii T. A Case of Thrombosed Inferior Mesenteric Artery Aneurysm Concomitant with Abdominal Aortic Aneurysm Treated by Endovascular Aneurysm Repair. Ann Vasc Dis 2021; 14:177-180. [PMID: 34239646 PMCID: PMC8241543 DOI: 10.3400/avd.cr.20-00171] [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: 12/17/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
A 71-year-old man was referred to our hospital under a diagnosis of abdominal aortic aneurysm (AAA). The past history of the patient included a sigmoid colectomy at 64 years old for an ischemic colitis. The maximum diameter of AAA was still 45 mm, and the inferior mesenteric artery (IMA) was aneurysmal and was 30 mm in diameter and thrombosed. The growth rate in the diameter of IMA aneurysm was 5 mm per year for the last 3 years. The patient successfully underwent endovascular aneurysm repair (EVAR), and the postoperative course was good. At 5 years after EVAR, computed tomography revealed a decrease in the diameter of both aneurysms.
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Affiliation(s)
- Yoichi Yamashita
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Sayako Nakagawa
- Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
| | - Kosuke Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Shohei Kitamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Taiko Horii
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
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Management and outcome of true visceral and renal artery aneurysm repair. Langenbecks Arch Surg 2021; 406:623-630. [PMID: 33755764 PMCID: PMC8106569 DOI: 10.1007/s00423-021-02149-1] [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: 07/24/2020] [Accepted: 03/07/2021] [Indexed: 11/03/2022]
Abstract
Purpose Visceral and renal artery aneurysms (VAA, RAA) are very rare pathologies. Both surgical and endovascular therapies are discussed as therapeutic options for ruptured and non-ruptured aneurysm repair; we describe our experience in the open and endovascular management of these entities. Methods Retrospective database analysis of 60 treated VAA and RAA in 59 patients between 1994 and 2020. Outcome data was descriptively analyzed. Results Thirty-seven aneurysms were surgically treated and 23 interventionally. In the total study cohort, we observed a mortality of 1.7% and a morbidity of 18.6%. One major complication occurred. The morbidity was higher after surgical repair in ruptured and non-ruptured cases. The mean aneurysm diameter was 30.5 ± 15.6 mm. Patients with hepatic or pancreaticoduodenal artery aneurysms presented more often in the stage of rupture, without differences in aneurysm size. The length of hospital stay after endovascular repair was significantly shorter compared to open surgical treatment (7.2 ± 6.9 days versus 11.8 ± 6.7 days, p = 0.014), but only in elective cases. Primary technical success was significantly better in patients that underwent surgical repair in an intention to treat analysis (100% versus 79.3%). The mean follow-up of the cohort was 53.5 months (range 3–207 months). Conclusion Elective endovascular therapy and open surgery of VAA and RAA are safe procedures with a good periprocedural and long-term outcome. Surgical revascularization showed a better primary technical success but was associated with longer length of hospital stays.
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An inferior mesenteric artery aneurysm in a patient with renal cell carcinoma. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:680-683. [PMID: 33403143 PMCID: PMC7759044 DOI: 10.5606/tgkdc.dergisi.2020.20392] [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: 06/25/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
An inferior mesenteric artery aneurysm is considered one of the visceral artery aneurysms, which is extremely rare, although its incidence of detection has been increasing in recent years. A 59-year-old male patient with a renal cell carcinoma in the left kidney was diagnosed with an inferior mesenteric artery aneurysm and treated surgically. Computed tomography revealed atrophy of the right kidney and occlusion of the celiac trunk, superior mesenteric artery, and left renal artery. There were no complications during the hospital stay and no mortality or morbidity was observed at three months of follow-up. In conclusion, the treatment of inferior mesenteric artery aneurysms is usually recommended, due to possible complications such as rupture and thromboembolism with high mortality and morbidity rates.
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Current management strategies for visceral artery aneurysms: an overview. Surg Today 2019; 50:38-49. [PMID: 31620866 PMCID: PMC6949316 DOI: 10.1007/s00595-019-01898-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/28/2019] [Indexed: 12/16/2022]
Abstract
Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.
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8
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Tan C, Reul R. Inferior mesenteric artery aneurysm in the setting of celiac and superior mesenteric artery occlusion. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:197-199. [PMID: 31193925 PMCID: PMC6545348 DOI: 10.1016/j.jvscit.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022]
Abstract
Inferior mesenteric artery (IMA) aneurysm is a rare type of visceral aneurysm. We present the case of a 77-year-old woman with an IMA aneurysm in the setting of chronic complete occlusion of the origins of her celiac artery and superior mesenteric artery. The patient was managed successfully with surgical excision of the IMA aneurysm with an end-to-side anastomosis of the IMA to the left common iliac artery. The case report is followed by a discussion based on a literature review of the few previously reported occurrences of IMA aneurysm.
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Affiliation(s)
- Corinne Tan
- Division of Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA
| | - Ross Reul
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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9
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Chen YA, Tai FC, Chen JH, Chen WL, Chung JY. Warfarin Overdose Associated Inferior Mesentery Artery Aneurysm Rupture Mimicking Spontaneous Bowel Hematoma. J Acute Med 2018; 8:186-189. [PMID: 32995222 PMCID: PMC7517977 DOI: 10.6705/j.jacme.201812_8(4).0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/14/2022]
Abstract
Inferior mesentery artery (IMA) aneurysm rupture is easily overlooked in patients with abdominal pain due to its uncommon occurrence. It may result in catastrophic consequence once misdiagnosed as spontaneous bowel hematoma in patients with anticoagulant overdose and intra-abdominal hematoma, as treatment strategy for both diseases varies differently. We present a case of a 70-year-old male who came to our emergency department with the chief complaint of abdominal pain over periumbilical area, eventually diagnosed as anticoagulant overdose associated IMA aneurysm rupture without occlusion of superior mesentery artery (SMA) and celiac artery (CA). This case report alerts us to consider the rare other source of bleeding, for instance ruptured inferior mesentery aneurysm, while encountering such an extraordinary large intra-abdominal hematoma in patients on anticoagulant.
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Affiliation(s)
- Yen-An Chen
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Feng-Chuan Tai
- Cathay General Hospital Department of Surgery Taipei Taiwan
| | - Jiann-Hwa Chen
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Wei-Lung Chen
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Jui-Yuan Chung
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
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Jesus-Silva SGD, Moraes-Silva MAD, Rieira BC, Nasser F, Cardoso RS. Short- and long-term follow-up after transarterial embolization of a giant inferior mesenteric artery aneurysm. J Vasc Surg Cases Innov Tech 2018; 4:315-318. [PMID: 30761376 PMCID: PMC6298940 DOI: 10.1016/j.jvscit.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/24/2018] [Indexed: 11/13/2022] Open
Abstract
Among the cases of visceral artery aneurysms, those that involve the inferior mesenteric artery are the most uncommon, with a prevalence of <1%. This study reports a giant symptomatic inferior mesenteric artery aneurysm and its endovascular treatment by means of percutaneous embolization with the implantation of pushable coils. After complete occlusion of the aneurysm, adequate maintenance of arterial supply of the left colon and resolution of the symptoms were observed. In the 2-year follow-up, a significant reduction in the aneurysm's volume and maintenance of the clinical condition were observed.
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Affiliation(s)
| | | | - Bruno Cardoso Rieira
- Department of Vascular and Endovascular Surgery, Hospital de Clínicas de Itajuba, Itajubá/MG, Brazil
| | - Felipe Nasser
- Department of Interventional Radiology, Albert Einstein Israeli Hospital, São Paulo, Brazil
| | - Rodolfo Souza Cardoso
- Department of Vascular and Endovascular Surgery, Hospital de Clínicas de Itajuba, Itajubá/MG, Brazil
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11
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Pisavadia B, Hanif M, Rana K, Budhoo M, Zaman S. A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery. Ann R Coll Surg Engl 2018; 100:e125-e127. [PMID: 29658342 DOI: 10.1308/rcsann.2018.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spontaneous splanchnic artery rupture is associated with up to 70% mortality. Affected vessels are often aneurysmal, secondary to atherosclerosis. We report, to our knowledge, the only case of spontaneous rupture of a branch of the left colic artery and the right gastric artery, possibly secondary to vasculitis.
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Affiliation(s)
- B Pisavadia
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - M Hanif
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - K Rana
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - M Budhoo
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - S Zaman
- Sandwell General Hospital , Lyndon, West Bromwich , UK
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Nagarajan K, Elango S, Ishita L, Shanmugam D. Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization. Cardiovasc Intervent Radiol 2016; 39:1358-60. [DOI: 10.1007/s00270-016-1338-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
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13
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Shawky MS, Tan J, French R. Gastroduodenal Artery Aneurysm: A Case Report and Concise Review of Literature. Ann Vasc Dis 2015; 8:331-3. [PMID: 26730262 DOI: 10.3400/avd.cr.15-00086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023] Open
Abstract
Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest aetiological factor. Its main complication is rupture, which is not uncommon and carries high risk of mortality. Clinical suspicion and advanced imaging tools should be employed in a timely fashion to make a diagnosis before this ominous event. We report a case of successfully treated GDA aneurysm who presented with minor bleeding episodes before suffering a major bleed and briefly discuss this pathology in light of the existing literature.
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Affiliation(s)
- Michael S Shawky
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Jeffrey Tan
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Rowan French
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
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Abstract
Visceral artery aneurysms (VAA) and pseudoaneurysms (VAPA) can be life-threatening conditions with high incidence of rupture and hemorrhage. Greater availability and increased use of advanced imaging technology has led to the increased incidental detection of asymptomatic visceral aneurysms. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic pseudoaneurysms. Due to this, both VAA and VAPA have become an increasingly frequent diagnosis confronting the vascular surgeon. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular occlusive and aneurysmal disease. All VAA and VAPA can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting, particularly in patients who are poor surgical candidates due to their comorbidities or who present a hostile abdomen. However, in the emergent setting it may carry a higher morbidity and mortality. We review the literature about open and endovascular approach for the treatment of VAA and VAPA both in the elective and emergent setting.
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Affiliation(s)
- Alfredo C Cordova
- Department of Surgery, Memorial Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA ; Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bauer E Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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