In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement
Autor(a) principal: | |
---|---|
Data de Publicação: | 2022 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1016/j.jvs.2022.03.869 http://hdl.handle.net/11449/241082 |
Resumo: | Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P < .001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P < .001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001), methicillin-resistant Staphylococcus aureus infection (HR, 1.7; 95% CI, 1.1-2.7; P = .02), as well as the protective effect of omental/muscle flap coverage (HR, 0.59; 95% CI, 0.37-0.92; P = .02). Conclusions: After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two and one-half-fold higher reinfection/mortality compared with ISB. Omental and/or muscle flap coverage of the repair appear protective. |
id |
UNSP_60e6e097ac1bfdc03ec88599580279d2 |
---|---|
oai_identifier_str |
oai:repositorio.unesp.br:11449/241082 |
network_acronym_str |
UNSP |
network_name_str |
Repositório Institucional da UNESP |
repository_id_str |
2946 |
spelling |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvementAntibiotic-soaked DacronAortic graft infectionAxillofemoral bypassCryopreserved allograftExtra-anatomic bypassIn situ bypassNeo-aortoiliac surgery (NAIS)Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P < .001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P < .001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001), methicillin-resistant Staphylococcus aureus infection (HR, 1.7; 95% CI, 1.1-2.7; P = .02), as well as the protective effect of omental/muscle flap coverage (HR, 0.59; 95% CI, 0.37-0.92; P = .02). Conclusions: After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two and one-half-fold higher reinfection/mortality compared with ISB. Omental and/or muscle flap coverage of the repair appear protective.Division of Vascular Surgery and Endovascular Therapy University Hospitals Cleveland Medical Center Case Western Reserve University School of MedicineDivision of Vascular Surgery Department of Surgery University of FloridaDepartment of Vascular and Endovascular Surgery Semmelweis UniversityDivision of Vascular and Endovascular Surgery Mayo ClinicDepartment of Vascular and Endovascular Surgery Massachusetts General HospitalDepartment of Vascular and Endovascular Surgery Brigham and Women's Hospital Harvard Medical SchoolDivision of Vascular Surgery Department of General Surgery Mayo Clinic ArizonaDivision of Vascular Surgery Department of Surgery Indiana UniversityDepartment of Cardiovascular Surgery University Heart Center Freiburg Bad KrozingenDivision of Vascular Surgery Department of Surgery UC Davis HealthTexas Vascular Associates The Heart Hospital PlanoDivision of Vascular Surgery Department of Surgery Kyung Hee University Hospital at GangdongGermanVasc Research Group Department of Vascular Medicine University Medical Center Hamburg-EppendorfDepartment of Vascular and Endovascular Surgery University of SienaDivision of Vascular Surgery Surgical Arts of St. LouisDepartment of Surgery and Orthopedics Botucatu School of Medicine Paulista State UniversityDivision of Vascular and Endovascular Surgery Cardiovascular Department University Hospital of TriesteDepartment of Vascular Surgery San Raffaele Scientific InstituteDivision of Vascular Diseases and Surgery Department of Surgery The Ohio State University College of MedicineDivision of Vascular Surgery and Endovascular Therapy Department of Surgery Johns Hopkins HospitalDivision of Vascular Surgery and Endovascular Therapy Department of Surgery University of Southern CaliforniaDivision of Vascular Surgery Department of Surgery Cedars-Sinai Medical CenterDivision of Vascular Surgery and Endovascular Therapy University of Alabama at BirminghamSection of Vascular Surgery Department of Surgical Sciences Uppsala UniversityDivision of Vascular Surgery and Endovascular Therapy Department of Surgery Hospital of the University of PennsylvaniaDivision of Vascular Surgery Department of Surgery University of ArizonaDepartment of Surgery Keio University School of Medicine ShinjukuDivision of Vascular and Endovascular Surgery Brooke Army Medical CenterDivision of Vascular Surgery Department of Surgery Saint Louis UniversityDivision of Vascular and Endovascular Surgery Beth Israel Deaconess Medical Center Harvard Medical SchoolDivision of Vascular Surgery St Elizabeth's HospitalDivision of Vascular Surgery Kaiser PermanenteDivision of Vascular Surgery and Endovascular Therapy Department of Surgery David Geffen School of Medicine University of California Los AngelesDivision of Vascular Surgery Department of Surgery Stanford University Medical CenterDepartment of Vascular Surgery Attikon University Hospital National & Kapodistrian University of AthensDivision of Vascular Surgery Department of Surgery University of North CarolinaDepartment of Clinical Research University of Poitiers Medical SchoolCardiovascular Surgical Clinics University of MissouriDivision of Vascular Surgery Penn State Health Heart and Vascular InstituteSection of Vascular Surgery Department of Surgery University of MichiganMedStar Heart and Vascular Institute Georgetown UniversityCardiovascular Center at Tufts Medical Center Tufts University School of MedicineDivision of Vascular Surgery Department of Surgery University of Washington School of MedicineDepartment of Vascular Surgery University of Patras Medical SchoolDivision of Vascular and Endovascular Therapy Michael E. DeBakey Department of Surgery Baylor College of MedicineDepartment of Surgery and Orthopedics Botucatu School of Medicine Paulista State UniversityCase Western Reserve University School of MedicineUniversity of FloridaSemmelweis UniversityMayo ClinicMassachusetts General HospitalHarvard Medical SchoolMayo Clinic ArizonaIndiana UniversityUniversity Heart Center Freiburg Bad KrozingenUC Davis HealthThe Heart Hospital PlanoKyung Hee University Hospital at GangdongUniversidade Estadual Paulista (UNESP)University of SienaSurgical Arts of St. LouisUniversity Hospital of TriesteSan Raffaele Scientific InstituteThe Ohio State University College of MedicineJohns Hopkins HospitalUniversity of Southern CaliforniaCedars-Sinai Medical CenterUniversity of Alabama at BirminghamUppsala UniversityHospital of the University of PennsylvaniaUniversity of ArizonaShinjukuBrooke Army Medical CenterSaint Louis UniversitySt Elizabeth's HospitalKaiser PermanenteUniversity of California Los AngelesStanford University Medical CenterNational & Kapodistrian University of AthensUniversity of North CarolinaUniversity of Poitiers Medical SchoolUniversity of MissouriPenn State Health Heart and Vascular InstituteUniversity of MichiganGeorgetown UniversityTufts University School of MedicineUniversity of Washington School of MedicineUniversity of Patras Medical SchoolBaylor College of MedicineJanko, Matthew R.Hubbard, GrantBack, MartinShah, Samir K.Pomozi, EnikoSzeberin, ZoltanDeMartino, RandallWang, Linda J.Crofts, SarahBelkin, MichaelDavila, Victor J.Lemmon, Gary W.Wang, Shihuan K.Czerny, MartinKreibich, MaximilianHumphries, Misty D.Shutze, WilliamJoh, Jin HyunCho, SungsinBehrendt, Christian-AlexanderSetacci, CarloHacker, Robert I.Sobreira, Marcone Lima [UNESP]Yoshida, Winston Bonetti [UNESP]D'Oria, MarioLepidi, SandroChiesa, RobertoKahlberg, AndreaGo, Michael R.Rizzo, Anthony N.Black, James H.Magee, Gregory A.Elsayed, RamseyBaril, Donald T.Beck, Adam W.McFarland, Graeme E.Gavali, HamidWanhainen, AndersKashyap, Vikram S.Stoecker, Jordan B.Wang, Grace J.Zhou, WeiFujimura, NaokiObara, HideakiWishy, Andrew M.Bose, SaideepSmeds, MatthewLiang, PatricSchermerhorn, MarcConrad, Mark F.Hsu, Jeffrey H.Patel, RhusheetLee, Jason T.Liapis, Christos D.Moulakakis, Konstantinos G.Farber, Mark A.Motta, FernandoRicco, Jean-BaptisteBath, JonathanCoselli, Joseph S.Aziz, FaisalColeman, Dawn M.Davis, Frank M.Fatima, JavairiahIrshad, AliShalhub, ShereneKakkos, StavrosZhang, QianziLawrence, Peter F.Woo, KarenChung, Jayer2023-03-01T20:46:14Z2023-03-01T20:46:14Z2022-08-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article546-555.e3http://dx.doi.org/10.1016/j.jvs.2022.03.869Journal of Vascular Surgery, v. 76, n. 2, p. 546-555.e3, 2022.1097-68090741-5214http://hdl.handle.net/11449/24108210.1016/j.jvs.2022.03.8692-s2.0-85131096454Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal of Vascular Surgeryinfo:eu-repo/semantics/openAccess2023-03-01T20:46:16Zoai:repositorio.unesp.br:11449/241082Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-03-01T20:46:16Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement |
title |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement |
spellingShingle |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement Janko, Matthew R. Antibiotic-soaked Dacron Aortic graft infection Axillofemoral bypass Cryopreserved allograft Extra-anatomic bypass In situ bypass Neo-aortoiliac surgery (NAIS) |
title_short |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement |
title_full |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement |
title_fullStr |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement |
title_full_unstemmed |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement |
title_sort |
In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement |
author |
Janko, Matthew R. |
author_facet |
Janko, Matthew R. Hubbard, Grant Back, Martin Shah, Samir K. Pomozi, Eniko Szeberin, Zoltan DeMartino, Randall Wang, Linda J. Crofts, Sarah Belkin, Michael Davila, Victor J. Lemmon, Gary W. Wang, Shihuan K. Czerny, Martin Kreibich, Maximilian Humphries, Misty D. Shutze, William Joh, Jin Hyun Cho, Sungsin Behrendt, Christian-Alexander Setacci, Carlo Hacker, Robert I. Sobreira, Marcone Lima [UNESP] Yoshida, Winston Bonetti [UNESP] D'Oria, Mario Lepidi, Sandro Chiesa, Roberto Kahlberg, Andrea Go, Michael R. Rizzo, Anthony N. Black, James H. Magee, Gregory A. Elsayed, Ramsey Baril, Donald T. Beck, Adam W. McFarland, Graeme E. Gavali, Hamid Wanhainen, Anders Kashyap, Vikram S. Stoecker, Jordan B. Wang, Grace J. Zhou, Wei Fujimura, Naoki Obara, Hideaki Wishy, Andrew M. Bose, Saideep Smeds, Matthew Liang, Patric Schermerhorn, Marc Conrad, Mark F. Hsu, Jeffrey H. Patel, Rhusheet Lee, Jason T. Liapis, Christos D. Moulakakis, Konstantinos G. Farber, Mark A. Motta, Fernando Ricco, Jean-Baptiste Bath, Jonathan Coselli, Joseph S. Aziz, Faisal Coleman, Dawn M. Davis, Frank M. Fatima, Javairiah Irshad, Ali Shalhub, Sherene Kakkos, Stavros Zhang, Qianzi Lawrence, Peter F. Woo, Karen Chung, Jayer |
author_role |
author |
author2 |
Hubbard, Grant Back, Martin Shah, Samir K. Pomozi, Eniko Szeberin, Zoltan DeMartino, Randall Wang, Linda J. Crofts, Sarah Belkin, Michael Davila, Victor J. Lemmon, Gary W. Wang, Shihuan K. Czerny, Martin Kreibich, Maximilian Humphries, Misty D. Shutze, William Joh, Jin Hyun Cho, Sungsin Behrendt, Christian-Alexander Setacci, Carlo Hacker, Robert I. Sobreira, Marcone Lima [UNESP] Yoshida, Winston Bonetti [UNESP] D'Oria, Mario Lepidi, Sandro Chiesa, Roberto Kahlberg, Andrea Go, Michael R. Rizzo, Anthony N. Black, James H. Magee, Gregory A. Elsayed, Ramsey Baril, Donald T. Beck, Adam W. McFarland, Graeme E. Gavali, Hamid Wanhainen, Anders Kashyap, Vikram S. Stoecker, Jordan B. Wang, Grace J. Zhou, Wei Fujimura, Naoki Obara, Hideaki Wishy, Andrew M. Bose, Saideep Smeds, Matthew Liang, Patric Schermerhorn, Marc Conrad, Mark F. Hsu, Jeffrey H. Patel, Rhusheet Lee, Jason T. Liapis, Christos D. Moulakakis, Konstantinos G. Farber, Mark A. Motta, Fernando Ricco, Jean-Baptiste Bath, Jonathan Coselli, Joseph S. Aziz, Faisal Coleman, Dawn M. Davis, Frank M. Fatima, Javairiah Irshad, Ali Shalhub, Sherene Kakkos, Stavros Zhang, Qianzi Lawrence, Peter F. Woo, Karen Chung, Jayer |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Case Western Reserve University School of Medicine University of Florida Semmelweis University Mayo Clinic Massachusetts General Hospital Harvard Medical School Mayo Clinic Arizona Indiana University University Heart Center Freiburg Bad Krozingen UC Davis Health The Heart Hospital Plano Kyung Hee University Hospital at Gangdong Universidade Estadual Paulista (UNESP) University of Siena Surgical Arts of St. Louis University Hospital of Trieste San Raffaele Scientific Institute The Ohio State University College of Medicine Johns Hopkins Hospital University of Southern California Cedars-Sinai Medical Center University of Alabama at Birmingham Uppsala University Hospital of the University of Pennsylvania University of Arizona Shinjuku Brooke Army Medical Center Saint Louis University St Elizabeth's Hospital Kaiser Permanente University of California Los Angeles Stanford University Medical Center National & Kapodistrian University of Athens University of North Carolina University of Poitiers Medical School University of Missouri Penn State Health Heart and Vascular Institute University of Michigan Georgetown University Tufts University School of Medicine University of Washington School of Medicine University of Patras Medical School Baylor College of Medicine |
dc.contributor.author.fl_str_mv |
Janko, Matthew R. Hubbard, Grant Back, Martin Shah, Samir K. Pomozi, Eniko Szeberin, Zoltan DeMartino, Randall Wang, Linda J. Crofts, Sarah Belkin, Michael Davila, Victor J. Lemmon, Gary W. Wang, Shihuan K. Czerny, Martin Kreibich, Maximilian Humphries, Misty D. Shutze, William Joh, Jin Hyun Cho, Sungsin Behrendt, Christian-Alexander Setacci, Carlo Hacker, Robert I. Sobreira, Marcone Lima [UNESP] Yoshida, Winston Bonetti [UNESP] D'Oria, Mario Lepidi, Sandro Chiesa, Roberto Kahlberg, Andrea Go, Michael R. Rizzo, Anthony N. Black, James H. Magee, Gregory A. Elsayed, Ramsey Baril, Donald T. Beck, Adam W. McFarland, Graeme E. Gavali, Hamid Wanhainen, Anders Kashyap, Vikram S. Stoecker, Jordan B. Wang, Grace J. Zhou, Wei Fujimura, Naoki Obara, Hideaki Wishy, Andrew M. Bose, Saideep Smeds, Matthew Liang, Patric Schermerhorn, Marc Conrad, Mark F. Hsu, Jeffrey H. Patel, Rhusheet Lee, Jason T. Liapis, Christos D. Moulakakis, Konstantinos G. Farber, Mark A. Motta, Fernando Ricco, Jean-Baptiste Bath, Jonathan Coselli, Joseph S. Aziz, Faisal Coleman, Dawn M. Davis, Frank M. Fatima, Javairiah Irshad, Ali Shalhub, Sherene Kakkos, Stavros Zhang, Qianzi Lawrence, Peter F. Woo, Karen Chung, Jayer |
dc.subject.por.fl_str_mv |
Antibiotic-soaked Dacron Aortic graft infection Axillofemoral bypass Cryopreserved allograft Extra-anatomic bypass In situ bypass Neo-aortoiliac surgery (NAIS) |
topic |
Antibiotic-soaked Dacron Aortic graft infection Axillofemoral bypass Cryopreserved allograft Extra-anatomic bypass In situ bypass Neo-aortoiliac surgery (NAIS) |
description |
Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P < .001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P < .001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001), methicillin-resistant Staphylococcus aureus infection (HR, 1.7; 95% CI, 1.1-2.7; P = .02), as well as the protective effect of omental/muscle flap coverage (HR, 0.59; 95% CI, 0.37-0.92; P = .02). Conclusions: After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two and one-half-fold higher reinfection/mortality compared with ISB. Omental and/or muscle flap coverage of the repair appear protective. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-08-01 2023-03-01T20:46:14Z 2023-03-01T20:46:14Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1016/j.jvs.2022.03.869 Journal of Vascular Surgery, v. 76, n. 2, p. 546-555.e3, 2022. 1097-6809 0741-5214 http://hdl.handle.net/11449/241082 10.1016/j.jvs.2022.03.869 2-s2.0-85131096454 |
url |
http://dx.doi.org/10.1016/j.jvs.2022.03.869 http://hdl.handle.net/11449/241082 |
identifier_str_mv |
Journal of Vascular Surgery, v. 76, n. 2, p. 546-555.e3, 2022. 1097-6809 0741-5214 10.1016/j.jvs.2022.03.869 2-s2.0-85131096454 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Journal of Vascular Surgery |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
546-555.e3 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1797790157745684480 |