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  1. Article ; Online: The "Dog Bone" Technique to Occlude a Branch Intentionally.

    Chisci, Emiliano / Dalla Caneva, Patrizia / Michelagnoli, Stefano

    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

    2021  Volume 61, Issue 6, Page(s) 1035

    MeSH term(s) Balloon Occlusion/instrumentation ; Balloon Occlusion/methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/instrumentation ; Blood Vessel Prosthesis Implantation/methods ; Humans ; Stents
    Language English
    Publishing date 2021-04-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 1225869-6
    ISSN 1532-2165 ; 1078-5884
    ISSN (online) 1532-2165
    ISSN 1078-5884
    DOI 10.1016/j.ejvs.2021.02.032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A Pilot Study of Endovascular Repair for Ruptured Aortic Aneurysms With the Use of Carbon Dioxide Angiography Alone.

    Massaini, Gianluca / Lazzarotto, Tommaso / Masciello, Fabrizio / Panci, Simone / Michelagnoli, Stefano / Chisci, Emiliano

    Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

    2023  , Page(s) 15266028231180995

    Abstract: Introduction: Endovascular aortic repair (EVAR) of a ruptured abdominal aortic aneurysm (rAAA) has become a common approach. Hemorrhagic shock associated with the use of iodinated contrast medium (ICM) increases the risk of acute kidney injury (AKI). ... ...

    Abstract Introduction: Endovascular aortic repair (EVAR) of a ruptured abdominal aortic aneurysm (rAAA) has become a common approach. Hemorrhagic shock associated with the use of iodinated contrast medium (ICM) increases the risk of acute kidney injury (AKI). Theoretically, eliminating ICM from EVAR can decrease that risk. The aim of this pilot study was to analyze the feasibility and safety of emergent EVAR performed with the exclusive use of carbon dioxide (CO
    Methods: Since 2021, all consecutive rAAAs with hemorrhagic shock and suitable anatomical criteria for a standard endograft have been treated by EVAR with the exclusive use of CO
    Results: Eight percutaneous EVARs were performed under local anesthesia. Median age was 78 (interquartile range [IQR]=6) years, 5 patients were male. The technical success was 100%, the 30-day mortality was 25% (n=2), the median amount of administered CO
    Conclusions: Endovascular repair of rAAA with the exclusive use of CO
    Clinical impact: The recorded rate of post-operative AKI after endovascular repair of rAAA performed with the use of CO
    Language English
    Publishing date 2023-06-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2006618-1
    ISSN 1545-1550 ; 1526-6028
    ISSN (online) 1545-1550
    ISSN 1526-6028
    DOI 10.1177/15266028231180995
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Reintervention rate after infrarenal aortic aneurysm repair is lower for open than endovascular repair with aneurysm sac shrinkage: a fifteen-year study.

    Chisci, Emiliano / Masciello, Fabrizio / Lazzarotto, Tommaso / Frosini, Pierfrancesco / Ercolini, Leonardo / Michelagnoli, Stefano

    International angiology : a journal of the International Union of Angiology

    2023  Volume 42, Issue 3, Page(s) 216–222

    Abstract: Background: The aim of this study was to report long-term results of infrarenal abdominal aortic aneurysm (AAA) in a single tertiary Hospital.: Methods: One thousand seven hundred seventy-seven consecutive AAA repairs (2003-2018) were included. ... ...

    Abstract Background: The aim of this study was to report long-term results of infrarenal abdominal aortic aneurysm (AAA) in a single tertiary Hospital.
    Methods: One thousand seven hundred seventy-seven consecutive AAA repairs (2003-2018) were included. Primary outcomes were all-cause mortality, AAA-related mortality, reinterventions rate. Open repair (OSR) was offered in case the patient had a functional capacity ≥4 metabolic equivalents (MET), and a predicted >10 year life expectancy. Endovascular repair (EVAR) was offered in case of hostile abdomen, presence of anatomic feasibility for standard endovascular graft, and <4 MET. Sac shrinkage was defined as a reduction of both anterior-posterior and latero-lateral diameter of the sac of at least 5 mm at the last follow-up vs. the first post- operative follow-up imaging.
    Results: Eight hundred twenty-eight (47%) OSRs and 949 (53%) EVARs were performed 90.6% (N.=1610) were male, mean age was 73.8 years. Mean follow-up was 79 (SD: 51) months. 30-day mortality was 0.7% (N.=6) and 0.6% (N.=6) for OSR and EVAR respectively (P=1). Long-term survival was better for OSR as expected by the selection criteria used (P<0.001), while AAA-related death was similar in the OSR vs. EVAR group (P=0.37); 664 (70%) sac shrinkages occurred at the last follow-up in the EVAR group. Freedom from reintervention was 97% and 96% at 1 year, 96.5% and 88.4% at 5 years, 95.8% vs. 81.7% at 10 years, and 94.6% vs.72.3% at 15 years for OSR and EVAR, respectively (P<0.001). The reintervention rate was significantly lower in the sac shrinkage vs. no-sac shrinkage subgroup and but higher than the OSR (P≤0.001). Any statistical difference was found for the survival outcome in case of sac shrinkage (P=0.1).
    Conclusions: Open repair of an infrarenal AAA had a lower reintervention rate than EVAR even in case of a shrinked sac at a long-term follow-up. Further studies with greater sample size are needed.
    MeSH term(s) Humans ; Male ; Aged ; Female ; Aortic Aneurysm, Abdominal/diagnostic imaging ; Aortic Aneurysm, Abdominal/surgery ; Tertiary Care Centers ; Endovascular Procedures/adverse effects
    Language English
    Publishing date 2023-05-24
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 604910-2
    ISSN 1827-1839 ; 0392-9590
    ISSN (online) 1827-1839
    ISSN 0392-9590
    DOI 10.23736/S0392-9590.23.05028-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Outcomes of popliteal artery aneurysms treated by ligation and in-situ saphenous vein bypass.

    Troisi, Nicola / Masciello, Fabrizio / Michelagnoli, Stefano / Chisci, Emiliano

    International angiology : a journal of the International Union of Angiology

    2021  Volume 40, Issue 5, Page(s) 435–441

    Abstract: Background: Modality of elective repair (open or endovascular) of popliteal artery aneurysms (PAAs) is still debated. About open repair no strict evidence exists about the best surgical technique. The aim of this study was to report a 20-year experience ...

    Abstract Background: Modality of elective repair (open or endovascular) of popliteal artery aneurysms (PAAs) is still debated. About open repair no strict evidence exists about the best surgical technique. The aim of this study was to report a 20-year experience with ligation and in-situ saphenous vein bypass for the elective treatment of PAAs.
    Methods: A retrospective review of consecutive patients who underwent elective open surgical PAA repair in our center between January 2001 and April 2020 was performed. Ninety-two limbs in 84 patients underwent a PAA ligation and in-situ saphenous bypass. Early (30 day) outcomes were assessed. Estimated 5-year outcomes according to Kaplan-Meier curves in terms of primary patency, primary assisted patency, secondary patency, and limb salvage were evaluated. Associations of patient and procedure variables with patency and limb salvage outcomes were sought with multivariate analysis.
    Results: Patients were predominantly male (80/84, 95.2%) with a mean age of 73.1 years (range 50-89). In all cases technical success was obtained. The mean hospital stay was 5.8 days (range 2-27). Thirty-day overall mortality (N.=1) and major amputation (N.=1) rates were both 1.2%. Mean duration of follow-up was 31.3 months (range: 1-168). At 5 years estimated rates of primary patency, primary assisted patency, secondary patency, and limb salvage were 76.3%, 81.5%, 89.9%, and 96.6%, respectively. On multivariate analysis the associations were: primary patency with PAA diameter >30 mm (P=0.007), and poor run-off status (P<0.001); primary assisted patency with poor run-off status (P<0.001); secondary patency with poor run-off status (P=0.04). Major amputation had no independent predictors of poor outcomes.
    Conclusions: Elective surgical treatment of PAAs with ligation and in-situ saphenous vein bypass is safe, effective and durable with good 5-year outcomes in terms of overall patency and limb salvage. Poor run-off status seemed to be an independent predictor of worse patency rates. This surgical technique should be cautiously applied in patients with PAAs with a diameter >30 mm.
    MeSH term(s) Aged ; Aged, 80 and over ; Aneurysm/diagnostic imaging ; Aneurysm/surgery ; Blood Vessel Prosthesis Implantation ; Humans ; Limb Salvage ; Male ; Middle Aged ; Popliteal Artery/diagnostic imaging ; Popliteal Artery/surgery ; Retrospective Studies ; Risk Factors ; Saphenous Vein/surgery ; Treatment Outcome ; Vascular Patency
    Language English
    Publishing date 2021-06-18
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 604910-2
    ISSN 1827-1839 ; 0392-9590
    ISSN (online) 1827-1839
    ISSN 0392-9590
    DOI 10.23736/S0392-9590.21.04708-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The Italian USL Toscana Centro model of a vascular hub responding to the COVID-19 emergency.

    Chisci, Emiliano / Masciello, Fabrizio / Michelagnoli, Stefano

    Journal of vascular surgery

    2020  Volume 72, Issue 1, Page(s) 8–11

    Abstract: Background: Spreading of the COVID-19 pandemic in Italy forced health facilities to drastically change their organization to face the overwhelming number of infected patients needing hospitalization. The aim of this paper is to share with all the ... ...

    Abstract Background: Spreading of the COVID-19 pandemic in Italy forced health facilities to drastically change their organization to face the overwhelming number of infected patients needing hospitalization. The aim of this paper is to share with all the vascular community the protocol developed by the USL (Unità Sanitaria Locale) Toscana Centro for the reorganization of the Vascular Surgery Unit during the COVID-19 emergency, hoping to help other institutions to face the emergency during the hard weeks coming.
    Methods: The USL Toscana Centro is a public Italian health care institution including four districts (Empoli, Florence, Pistoia, Prato) with 13 different hospitals, serving more than 1,500,000 people in a 5000 km2 area. The USL adopted a protocol of reorganization of the Vascular Surgery Unit during the first difficult weeks of the epidemic, consisting in the creation of a Vascular Hub for urgent cases, with a profound reorganization of activities, wards, surgical operators, operating blocks, and intensive care unit (ICU) beds.
    Results: All 13 hospitals are now COVID-19 as the first days of April passed. The San Giovanni di Dio Hospital (Florence) has more than 80 COVID-19 patients in different settings (ICU, medical and surgical ward), which at the time of writing is almost one-third of the total hospital capacity (80/260 beds). It has been identified as the Surgical Hub for urgent vascular COVID-19 cases. Therefore, the elective surgical and office activities were reduced by 30% and 80%, respectively, and reserved to priority cases. A corner of the whole operating block, well separate from the remaining operating rooms, was rapidly converted into one operating room and six ICU beds dedicated to COVID patients. The COVID-19 surgical path now includes an emergency room for suspected COVID-19 patients directly connected to an elevator for the transfer of COVID patients in the COVID operating block and dedicated COVID-19 ward and ICU beds.
    Conclusions: Rapid modification of hospital settings, a certain "flexibility" of the medical personnel, a stepwise shutdown of vascular surgical and office activity, and the necessity of a strong leadership are mandatory to cope with the tsunami of the COVID-19 outbreak.
    MeSH term(s) Betacoronavirus/pathogenicity ; COVID-19 ; Clinical Protocols ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Coronavirus Infections/virology ; Critical Care/organization & administration ; Emergencies/epidemiology ; Emergency Service, Hospital/organization & administration ; Hospital Restructuring ; Hospitals, Public/organization & administration ; Humans ; Intensive Care Units/organization & administration ; Italy/epidemiology ; Models, Organizational ; Operating Rooms/organization & administration ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Pneumonia, Viral/virology ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-04-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2020.04.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Open vascular surgery training in the endovascular era: 5-year experience with cadaver laboratory.

    Garriboli, Luca / Chisci, Emiliano / Antonello, Michele / Parlani, Gianbattista / Civilini, Efrem / Maritati, Gabriele / Troisi, Nicola

    International angiology : a journal of the International Union of Angiology

    2022  Volume 41, Issue 2, Page(s) 177–182

    Abstract: Background: Vascular cadaver laboratory (CAD LAB) courses included vascular exposure techniques and simulations of open procedures. Aim of the study was to demonstrate the benefit of cadaver laboratory (CAD LAB) courses to improve trainees' experience ... ...

    Abstract Background: Vascular cadaver laboratory (CAD LAB) courses included vascular exposure techniques and simulations of open procedures. Aim of the study was to demonstrate the benefit of cadaver laboratory (CAD LAB) courses to improve trainees' experience in open surgical vascular procedures.
    Methods: Between 2014 and 2020, 162 vascular surgeons or medical trainees (mean age 28 years) participated in vascular CAD LAB courses in Italy and France. Outcomes were measured using the Linkert survey, performed pre- and postcourse to evaluate self-efficacy/confidence, surgical experience, and resident perception of the course with a range score from 0 to 5 for each point. Anatomical knowledge improvement was measured using a questionnaire with multiple answers pre- and postcourse. The course was considered to have yielded a positive result if the postcourse Linkert Survey Score increased by ≥2 points, or in the case of an increase of at least 30% above the baseline value of the multiple questionnaires.
    Results: Postcourse questionnaires were positive for all outcomes evaluated. Participants' perception of the usefulness of the CAD LAB evaluation was 4.8 out of 5. For the vascular CAD LAB, participant anatomical knowledge improved overall from an average of 55% to 93% (P<0.001), and self-efficacy/confidence improved from 2.3 to 4.5 out of 5 (P<0.001). Regarding the different operative procedures, the greatest self-efficacy/confidence improvement was recorded in carotid endarterectomy and aortic procedures (+50% and +66% respectively; P<0.001). The city location (Italy vs. France) did not affect the results.
    Conclusions: CAD LAB courses were shown to be effective in increasing participants' self-efficacy, confidence, and anatomical knowledge in open vascular surgical procedures.
    MeSH term(s) Adult ; Cadaver ; Clinical Competence ; Curriculum ; Education, Medical, Graduate ; Humans ; Internship and Residency ; Vascular Surgical Procedures/education
    Language English
    Publishing date 2022-02-03
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 604910-2
    ISSN 1827-1839 ; 0392-9590
    ISSN (online) 1827-1839
    ISSN 0392-9590
    DOI 10.23736/S0392-9590.22.04808-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study.

    Saratzis, Athanasios / Torsello, Giovanni B / Cardona-Gloria, Yamel / Van Herzeele, Isabelle / Messeder, Sarah J / Zayed, Hany / Torsello, Giovanni F / Chisci, Emiliano / Isernia, Giacomo / D'Oria, Mario / Stavroulakis, Konstantinos

    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

    2024  

    Abstract: Objective: To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective.: Methods: European multicentre study involving ... ...

    Abstract Objective: To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective.
    Methods: European multicentre study involving consecutive patients requiring femoropopliteal TLR (January 2017 - December 2021). The primary outcome was overall cost (euros) associated with a TLR procedure from presentation to discharge. Exact costs per constituent, clinical characteristics, and early outcomes were reported.
    Results: This study included 482 TLR procedures (retrospectively, 13 hospitals, six countries): 56% were female, mean age was 75 ± 2 years, 61% were Rutherford class 5 or 6, 67% had Tosaka class 3 disease, and 16% had common femoral or iliac involvement. A total of 52% were hybrid procedures and 6% involved open surgery only. Technical success was 70%, 30 day mortality rate was 1%, and the 30 day major amputation rate was 4%. Most costs were for operating time during the TLR (healthcare professionals' salaries, indirect and estate costs), with a mean of: €21 917 ± €2 110 for all procedures; €23 337 ± €8 920 for open procedures; €12 903 ± €3 108 for endovascular procedures; and €22 806 ± €3 977 for hybrid procedures. In a regression analysis, procedure duration was the main parameter associated with higher overall TLR costs (coefficient, 2.77; standard error, 0.88; p < .001). The mean cost per operating minute of TLR (indirect, estate costs, all salaried staff present included) was €177 and the mean cost per night stay in hospital (outside intensive care unit) was €356. The mean cost per overnight intensive care unit stay (minimum of 8 hours per night) was €1 193.
    Conclusion: The main driver of the considerable peri-procedure costs associated with femoropopliteal TLR was procedure time.
    Language English
    Publishing date 2024-02-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1225869-6
    ISSN 1532-2165 ; 1078-5884
    ISSN (online) 1532-2165
    ISSN 1078-5884
    DOI 10.1016/j.ejvs.2024.02.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The Italian USL Toscana Centro model of a vascular hub responding to the COVID-19 emergency

    Chisci, Emiliano / Masciello, Fabrizio / Michelagnoli, Stefano

    Journal of Vascular Surgery

    2020  Volume 72, Issue 1, Page(s) 8–11

    Keywords Surgery ; Cardiology and Cardiovascular Medicine ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2020.04.019
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Benefits and Role of Carbon Dioxide Angiography in Case of Misalignment Between Fenestration and Target Vessel During Fenestrated Endovascular Aneurysm Repair.

    Chisci, Emiliano / Michelagnoli, Stefano / Masciello, Fabrizio / Turini, Filippo / Panci, Simone / Troisi, Nicola

    Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

    2021  Volume 29, Issue 1, Page(s) 7–10

    Abstract: Purpose: To report the benefits and the role of carbon dioxide (CO: Technique: During F-EVAR, misalignment between fenestration and target vessel is a potentially catastrophic complication. In 2 patients, we experienced that one of the target vessels ...

    Abstract Purpose: To report the benefits and the role of carbon dioxide (CO
    Technique: During F-EVAR, misalignment between fenestration and target vessel is a potentially catastrophic complication. In 2 patients, we experienced that one of the target vessels were not visible during standard angiography in different projections after positioning a fenestrated graft and even after cannulation of the corresponding fenestration. In both cases, the graft was sealed to the aortic wall but not in the predictable position. Consequently, acute occlusion of the target vessel was hypothesized. However, CO
    Conclusion: In case of misalignment of a fenestration during F-EVAR and non-visualization of the target vessel with standard angiography, CO
    MeSH term(s) Aortic Aneurysm, Abdominal/diagnostic imaging ; Aortic Aneurysm, Abdominal/surgery ; Aortography ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Carbon Dioxide ; Endovascular Procedures/adverse effects ; Humans ; Prosthesis Design ; Retrospective Studies ; Stents ; Treatment Outcome
    Chemical Substances Carbon Dioxide (142M471B3J)
    Language English
    Publishing date 2021-08-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2006618-1
    ISSN 1545-1550 ; 1526-6028
    ISSN (online) 1545-1550
    ISSN 1526-6028
    DOI 10.1177/15266028211032955
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: A comparative analysis of anatomical variations of popliteal artery and its branches in concomitant aneurysmal disease.

    Troisi, Nicola / Melani, Alberto / Raspanti, Claudio / Panci, Simone / Chisci, Emiliano / Pratesi, Carlo / Michelagnoli, Stefano

    Vascular

    2021  Volume 31, Issue 1, Page(s) 33–38

    Abstract: Objectives: Open or endovascular treatment of popliteal artery aneurysms (PAAs) is still debated. Data about the popliteal artery anatomy and its branches are essential to plan a surgical approach. The aim of this study was to report the anatomical ... ...

    Abstract Objectives: Open or endovascular treatment of popliteal artery aneurysms (PAAs) is still debated. Data about the popliteal artery anatomy and its branches are essential to plan a surgical approach. The aim of this study was to report the anatomical variations of the popliteal artery and its branches in a population with aneurysmal disease and compare them with a standard population with non-aneurysmal disease.
    Methods: A retrospective review of consecutive patients who underwent surgical PAA repair in our center between January 2011 and December 2020 was performed. One-hundred-forty-six limbs in 128 patients underwent PAA treatment (Group 1). Computed tomography angiography images using a 128-section configuration were reviewed for anatomical variations of the popliteal artery and its branches. A control population of 178 limbs in 89 patients with non-aneurysmal disease was used to compare the outcomes (Group 2). All limbs were classified according to Kim's classification. The two groups were analyzed and compared by means of nonparametric Pearson chi-square test.
    Results: Both groups were homogeneous in terms of demographics, risk factors, and clinical presentation. In Group 1, the limbs with PAA were classified as type IA, 133 (91.1%); type IB, 2 (1.4%); type IC, 0; type IIA1, 1 (0.7%); type IIA2, 1 (0.7%); type IIB, 4 (2.7%); type IIC, 0; type IIIA, 3 (2.1%); type IIIB, 0; and type IIIC, 2 (1.4%). In Group 2 the limbs with non-aneurysmal disease were classified as type IA, 163 (91.6%); type IB, 5 (2.8%); type IC, 1 (0.6%); type IIA1, 1 (0.6%); type IIA2, 3 (1.7%); type IIB, 2 (1.1%); type IIC, 0; type IIIA, 3 (1.7%); type IIIB, 0; and type IIIC, 0. No difference in terms of anatomy of the popliteal artery and its branches was found between the two groups (
    Conclusions: Knowledge of anatomical variations of the popliteal artery and its branches is mandatory in case of the surgical approach. Anatomy in PAA patients is not different. Studies with larger population size are needed to validate these outcomes.
    MeSH term(s) Humans ; Popliteal Artery/diagnostic imaging ; Popliteal Artery/surgery ; Aneurysm/diagnostic imaging ; Aneurysm/surgery ; Aneurysm/complications ; Lower Extremity/surgery ; Retrospective Studies ; Angiography ; Treatment Outcome ; Vascular Patency ; Blood Vessel Prosthesis Implantation
    Language English
    Publishing date 2021-11-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 2137151-9
    ISSN 1708-539X ; 1708-5381
    ISSN (online) 1708-539X
    ISSN 1708-5381
    DOI 10.1177/17085381211052369
    Database MEDical Literature Analysis and Retrieval System OnLINE

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