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Carotid Reconstruction With Bovine Carotid Heterograft After En Bloc Resection of Squamous Cell Carcinoma With Direct Internal Carotid Invasion
JOURNAL OF VASCULAR SURGERY Volume 62, Number 3
Abstracts 801
popliteal artery with medial displacement suggestive of PAES. The patient was taken to the operating room for right popliteal artery exploration via posterior approach. A type III PAES was identified intraoperatively (Fig). The accessory slip of muscle from the medial head of gastrocnemius muscle was divided. A balloon thromboembolectomy was performed through a longitudinal arteriotomy and the artery was patched with bovine pericardium. Results: Postoperatively, the patient recovered well and was neurologically intact with normal pedal pulses. She was seen by obstetrics and underwent fetal heart rate monitoring. She was started on 81-mg aspirin daily and was discharged home on postoperative day 4. She was seen in follow-up by vascular surgery and in consultation with maternal fetal medicine because she was previously cared for by nurse midwives. Conclusions: Nonatheromatous popliteal artery pathology should be considered in young active patients who present with intermittent claudication or acute limb ischemia. The pregnant woman warrants a discussion of safe imaging modalities to establish a diagnosis and anesthesia considerations for surgical repair. Although we know strenuous exercise predisposes patients to symptomatic PAES, pregnancy is a hypercoagulable state and may be an independent risk factor.
Conclusions: This study suggests that technical skills can improve in a simulated AAA model irrespective of the stress level experienced by the participant. These findings raise questions about the impact of stress on surgical education and acquisition of technical skills. Studies using robust physiological stress measures are needed to potentially identify beneficial or detrimental levels of stress in training outcomes. Author Disclosures: M. Kiguchi: None; J. Bath: None; D. G. Winger: None; M. S. Makaroun: None; R. Chaer: None. Carotid Reconstruction With Bovine Carotid Heterograft After En Bloc Resection of Squamous Cell Carcinoma With Direct Internal Carotid Invasion Eric B. Trestman, MD, Pablo De Los Santos, MD, Evan Garfein, MD, Thomas Ow, MD, Evan C. Lipsitz, MD, Saadat Shariff, MD. Montefiore Medical Center, Bronx, NY Objectives: We report a novel use of the Artegraft (North Brunswick, NJ) bovine heterograft for carotid reconstruction after resection of a neck squamous cell carcinoma.
Author Disclosures: B. Song: None; M. Obmann: None; S. Nikam: None; D. Mariner: None; S. Wang: None; M. D. Leonard: None. An Unusual Presentation of Bilateral Hypothenar Hammer Syndrome John P. Phair, Charles S. Decarlo, Eric B. Trestman, Karan Garg This abstract has been published in the Abstracts of the 2015 Vascular Annual Meeting: The Society for Vascular Surgery. DOI: http://dx.doi. org/10.1016/j.jvs2015.04.207. The Effect of Stress on Task Acquisition in a Simulated Open Aortic Aneurysm Model Misaki Kiguchi, MD, MBA1, Jonathan Bath, MD2, Daniel G. Winger, MS3, Michel S. Makaroun, MD1, Rabih Chaer, MD1. 1University of Pittsburgh Medical Center, Pittsburgh, Pa; 2University of Cincinnati, Cincinnati, Ohio; 3University of Pittsburgh, Pittsburgh, Pa Objectives: This study evaluated high levels of teaching stress compared with a nonstressful environment and its effects on standardized performance measures on an open abdominal aortic aneurysm (AAA) model using validated psychological and hemodynamic parameters. Methods: Participants were randomly divided into two groups of simulated open aortic tube graft repair for three sessions. Session 1 involved familiarization with the model and baseline stress and performance measures. Sessions 2 and 3 involved the use of supportive feedback for the control group with no stress (NS), and verbal and situational stressors for the intervention or stress (S) group. Stress levels were assessed by heart rate, blood pressure, and self-reported validated measure of stress levels (State Trait Anxiety Index [STAI]), immediately after each session. Performance measures were assessed by Objective Structured Assessment of Technical Skills (OSATS) and Global Performance Rating (GPR) tools. Session 3 performance was compared with the baseline performance at session 1. Statistical methods for comparison involved the sampled t-test (P < .05). Results: Ten medical students participated. Within each group, OSATS scores significantly improved (3.88 points for NS, P ¼ .003; 4.33 points for S, P ¼ .003). GPR scores significantly improved (6.88 points for NS, P ¼ .004; 5.33 points for S, P ¼ .023). Between the two groups (Table), the S group’s stress level increased with a STAI increase of 9.17 points, whereas the NS group’s STAI score decreased 6.25 points (P ¼ .001). Despite the increase in the anxiety measure, OSATS and GPR performance did not differ significantly between the groups from session 1 to session 3.
Fig 1. Coronal maximum intensity projection reconstruction of large squamous cell carcinoma mass of the left neck.
Table. Between-group comparisons between session 3 and 1 Measurement OSATS GPR Blood pressure Systolic Diastolic Pulse pressure Pulse State Trait
Control group (NS) (n ¼ 4)
Intervention group (S) (n ¼ 6)
P value
3.875 6.875
4.333 5.333
.669 .496
15.5 9.50 6.00 7.00 6.250 3.250
9.00 3.33 5.67 0.667 9.167 4.667
.542 .263 .967 .263 .001 .802
GPR, Global Performance Rating; NS, no stress; OSATS, Objective Structured Assessment of Technical Skills; S, stress.
Fig 2. Interposition bypass reconstruction of the left internal carotid artery with the Artegraft.
JOURNAL OF VASCULAR SURGERY September 2015
802 Abstracts
Methods: We performed an extensive literature search using PubMed and found 274 articles referencing tumor invasion of the carotid, with 31 articles describing carotid reconstruction in the setting of tumor invasion. There were no reports using Artegraft for carotid reconstruction. Results: A 65-year-old man presented with a large left neck mass. Computed tomography angiography (CTA) of the neck demonstrated a complex 9.1-cm 5.9-cm 7.5-cm mass encasing and invading the cervical internal carotid artery (Fig 1). Fine-needle aspiration revealed squamous cell carcinoma. Furthermore, he had an incomplete circle of Willis on CTA and no viable vein conduit on duplex mapping. The patient underwent en bloc resection of the left neck tumor, including a portion of the cervical internal carotid artery, followed by reconstruction with the Artegraft (Fig 2). Brachytherapy catheters were left in place, followed by pectoralis major rotational flap for coverage. At the conclusion of the procedure, there were multiphasic Doppler signals throughout the graft. The procedure was well tolerated, and the patient had an uneventful course with no neurologic sequelae. Conclusions: To our knowledge, this is the first case reported of tumor invasion of the internal carotid reconstructed using Artegraft bovine heterograft as conduit. This novel approach provides an alternative to synthetic conduit when there is an increased concern for infection and need for a durable repair in a patient without suitable autologous conduit. Author Disclosures: E. B. Trestman: None; P. De Los Santos: None; E. Garfein: None; T. Ow: None; E. C. Lipsitz: None; S. Shariff: None. Outcomes for Carotid Blowout Interventions in Patients With Head and Neck Cancer Nathan L. Liang, MD1, Brian D. Guedes, BS2, Umamaheswar Duvvuri, MD1, Michael J. Singh, MD1, Rabih A. Chaer, MD, MSc1, Michel S. Makaroun, MD1, Ulka Sachdev, MD1. 1University of Pittsburgh Medical Center, Pittsburgh, Pa; 2University of Pittsburgh, Pittsburgh, Pa Objectives: The purpose of this study was to examine the characteristics and outcomes of a patient cohort undergoing intervention for carotid blowout syndrome (CBS) associated with head and neck cancer. Methods: Patients with head and neck cancer who presented with carotid-distribution bleeding from 2000 to 2014 were identified in the medical record. Standard statistical methods and survival analysis were used to analyze study population characteristics and outcomes. Results: The study included 37 patients (74% male). The mean age was 60.1 6 11.4 years. All malignancies were squamous cell type, stage IV, in a variety of primary locations: 32% oral cavity, 24% larynx, 16% superficial neck, with the remainder in the oropharynx, nasopharynx, and hypopharynx. Fifty-one percent of hemorrhages were common carotid, 29% were external carotid, and 19% were internal carotid distribution. Sixty-eight percent presented with acute hemorrhage, 24% with impending, and 8% with threatened hemorrhage. All patients underwent intervention: 38% received endovascular coil embolization, 30% stent grafts, 22% surgical ligation, and 10% primary vessel repair or bypass grafting. Complications included perioperative stroke in 10.8% of patients; other major complications were rare. Estimated recurrent bleeding risk was 24% at 30 days and 34% at 6 months. Prior neck dissection was the only significant factor associated with recurrent bleeding. Most patients (91.9%) survived to hospital discharge. The 90-day and 1-year estimated survival was 60.9% and 36.6%, respectively. Conclusions: CBS associated with head and neck cancer carries poor midterm and long-term prognoses; however, mortality may be related more to the advanced stage of disease rather than carotid involvement or associated intervention. Surgical and endovascular approaches may both be efficacious in cases of acute hemorrhage but carry a significant risk of periprocedural stroke.
Table. Limb salvage after infrainguinal bypass in patients on hemodialysis Limb salvage White % (95% CI) Black % (95% CI) Hispanic % (95% CI) 1 2 3 4
year years years years
69.1 60.2 53.6 47.8
(67.8-70.4) (58.6-61.8) (51.7-55.5) (45.3-50.3)
61.2 51.9 45.6 40.7
(59.5-62.8) (50.0-53.7) (43.6-47.7) (38.3-43.1)
62.3 54.5 46.7 38.1
(58.7-65.8) (50.5-58.4) (42.2-51.5) (31.7-44.6)
CI, Confidence interval. Kaplan-Meier and multivariate Cox regression analyses adjusting for patient characteristics were used to evaluate long-term limb salvage. Results: There were 12,491 infrainguinal OBSs placed in this cohort with a mean follow-up of 1.4 (standard deviation, 1.32) years. The mean age was 63 (standard deviation, 12.2) years and 62% of patients were male, and 54% were white vs 35% black, 7% Hispanic, and 4% others. Overall, 30-day perioperative graft failure and death rates were 7.7% and 7.5%, respectively. Limb salvage was 66% at 1 year, 57% at 2 years, 51% at 3 years, and 45% at 4 years (Table). The significant predictors of long-term limb loss were male gender (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.05-1.26; P < .05), black race (HR, 1.32; 95% CI, 1.19-1.46; P < .001), and immobility (HR, 1.31; 95% CI, 1.11-1.55; P < .001). Conclusions: This is the largest study to date to evaluate the longterm outcomes of limb salvage in patients on HD. This study confirms overall worse outcomes in this population and highlights the racial disparity in limb salvage after revascularization. Author Disclosures: M. B. Malas: None; I. J. Arhuidese: None; T. Obeid: None; C. W. Hicks: None; U. Qazi: None; D. Segev: None. Carotid-Carotid-Subclavian Artery Bypass for Ruptured Mycotic Pseudoaneurysm of Innominate Artery Ratna C. Medicherla, MD, Jennifer Stableford, MD, Saadat Shariff, MD, Pablo de los Santos, MD, Richard Smith, MD, William Jakobleff Jr, MD, Joseph Derose, MD, Evan Lipsitz, MD, Jeffrey Kirk, MD. Montefiore Medical Center, Bronx, NY Objectives: Mycotic pseudoaneurysms of the innominate artery (PAIA) are a rare entity. We report a patient with a symptomatic PAIA
Author Disclosures: N. L. Liang: None; B. D. Guedes: None; U. Duvvuri: None; M. J. Singh: None; R. A. Chaer: None; M. S. Makaroun: None; U. Sachdev: None. Racial Disparity in Limb Salvage Following Revascularization in Patients on Hemodialysis Mahmoud B. Malas, MD, MHS, Isibor J. Arhuidese, MD, MPH, Tammam Obeid, MD, Caitlin W. Hicks, MD, MS, Umair Qazi, MD, MPH, Dorry Segev, MD, PhD. Johns Hopkins Medical Institutions, Baltimore, Md Objectives: Prior reports of outcomes after infrainguinal open bypass surgery (OBS) in patients with end-stage renal disease (ESRD) on hemodialysis (HD) have been based on small-sample institutional series. In addition, race is known to have a marked impact on outcomes in the HD population. In this study, we evaluate the effects of race on long-term OBS outcomes from a nationally representative cohort of HD patients. Methods: We studied all HD patients who underwent infrainguinal OBS in the United States Renal Disease System database between January 2006 and December 2011. Univariate methods (c2, analysis of variance) were used to compare patients’ demographic and medical characteristics.
Fig. Innominate artery pseudoaneurysm (IAPA).
Abstracts 801
popliteal artery with medial displacement suggestive of PAES. The patient was taken to the operating room for right popliteal artery exploration via posterior approach. A type III PAES was identified intraoperatively (Fig). The accessory slip of muscle from the medial head of gastrocnemius muscle was divided. A balloon thromboembolectomy was performed through a longitudinal arteriotomy and the artery was patched with bovine pericardium. Results: Postoperatively, the patient recovered well and was neurologically intact with normal pedal pulses. She was seen by obstetrics and underwent fetal heart rate monitoring. She was started on 81-mg aspirin daily and was discharged home on postoperative day 4. She was seen in follow-up by vascular surgery and in consultation with maternal fetal medicine because she was previously cared for by nurse midwives. Conclusions: Nonatheromatous popliteal artery pathology should be considered in young active patients who present with intermittent claudication or acute limb ischemia. The pregnant woman warrants a discussion of safe imaging modalities to establish a diagnosis and anesthesia considerations for surgical repair. Although we know strenuous exercise predisposes patients to symptomatic PAES, pregnancy is a hypercoagulable state and may be an independent risk factor.
Conclusions: This study suggests that technical skills can improve in a simulated AAA model irrespective of the stress level experienced by the participant. These findings raise questions about the impact of stress on surgical education and acquisition of technical skills. Studies using robust physiological stress measures are needed to potentially identify beneficial or detrimental levels of stress in training outcomes. Author Disclosures: M. Kiguchi: None; J. Bath: None; D. G. Winger: None; M. S. Makaroun: None; R. Chaer: None. Carotid Reconstruction With Bovine Carotid Heterograft After En Bloc Resection of Squamous Cell Carcinoma With Direct Internal Carotid Invasion Eric B. Trestman, MD, Pablo De Los Santos, MD, Evan Garfein, MD, Thomas Ow, MD, Evan C. Lipsitz, MD, Saadat Shariff, MD. Montefiore Medical Center, Bronx, NY Objectives: We report a novel use of the Artegraft (North Brunswick, NJ) bovine heterograft for carotid reconstruction after resection of a neck squamous cell carcinoma.
Author Disclosures: B. Song: None; M. Obmann: None; S. Nikam: None; D. Mariner: None; S. Wang: None; M. D. Leonard: None. An Unusual Presentation of Bilateral Hypothenar Hammer Syndrome John P. Phair, Charles S. Decarlo, Eric B. Trestman, Karan Garg This abstract has been published in the Abstracts of the 2015 Vascular Annual Meeting: The Society for Vascular Surgery. DOI: http://dx.doi. org/10.1016/j.jvs2015.04.207. The Effect of Stress on Task Acquisition in a Simulated Open Aortic Aneurysm Model Misaki Kiguchi, MD, MBA1, Jonathan Bath, MD2, Daniel G. Winger, MS3, Michel S. Makaroun, MD1, Rabih Chaer, MD1. 1University of Pittsburgh Medical Center, Pittsburgh, Pa; 2University of Cincinnati, Cincinnati, Ohio; 3University of Pittsburgh, Pittsburgh, Pa Objectives: This study evaluated high levels of teaching stress compared with a nonstressful environment and its effects on standardized performance measures on an open abdominal aortic aneurysm (AAA) model using validated psychological and hemodynamic parameters. Methods: Participants were randomly divided into two groups of simulated open aortic tube graft repair for three sessions. Session 1 involved familiarization with the model and baseline stress and performance measures. Sessions 2 and 3 involved the use of supportive feedback for the control group with no stress (NS), and verbal and situational stressors for the intervention or stress (S) group. Stress levels were assessed by heart rate, blood pressure, and self-reported validated measure of stress levels (State Trait Anxiety Index [STAI]), immediately after each session. Performance measures were assessed by Objective Structured Assessment of Technical Skills (OSATS) and Global Performance Rating (GPR) tools. Session 3 performance was compared with the baseline performance at session 1. Statistical methods for comparison involved the sampled t-test (P < .05). Results: Ten medical students participated. Within each group, OSATS scores significantly improved (3.88 points for NS, P ¼ .003; 4.33 points for S, P ¼ .003). GPR scores significantly improved (6.88 points for NS, P ¼ .004; 5.33 points for S, P ¼ .023). Between the two groups (Table), the S group’s stress level increased with a STAI increase of 9.17 points, whereas the NS group’s STAI score decreased 6.25 points (P ¼ .001). Despite the increase in the anxiety measure, OSATS and GPR performance did not differ significantly between the groups from session 1 to session 3.
Fig 1. Coronal maximum intensity projection reconstruction of large squamous cell carcinoma mass of the left neck.
Table. Between-group comparisons between session 3 and 1 Measurement OSATS GPR Blood pressure Systolic Diastolic Pulse pressure Pulse State Trait
Control group (NS) (n ¼ 4)
Intervention group (S) (n ¼ 6)
P value
3.875 6.875
4.333 5.333
.669 .496
15.5 9.50 6.00 7.00 6.250 3.250
9.00 3.33 5.67 0.667 9.167 4.667
.542 .263 .967 .263 .001 .802
GPR, Global Performance Rating; NS, no stress; OSATS, Objective Structured Assessment of Technical Skills; S, stress.
Fig 2. Interposition bypass reconstruction of the left internal carotid artery with the Artegraft.
JOURNAL OF VASCULAR SURGERY September 2015
802 Abstracts
Methods: We performed an extensive literature search using PubMed and found 274 articles referencing tumor invasion of the carotid, with 31 articles describing carotid reconstruction in the setting of tumor invasion. There were no reports using Artegraft for carotid reconstruction. Results: A 65-year-old man presented with a large left neck mass. Computed tomography angiography (CTA) of the neck demonstrated a complex 9.1-cm 5.9-cm 7.5-cm mass encasing and invading the cervical internal carotid artery (Fig 1). Fine-needle aspiration revealed squamous cell carcinoma. Furthermore, he had an incomplete circle of Willis on CTA and no viable vein conduit on duplex mapping. The patient underwent en bloc resection of the left neck tumor, including a portion of the cervical internal carotid artery, followed by reconstruction with the Artegraft (Fig 2). Brachytherapy catheters were left in place, followed by pectoralis major rotational flap for coverage. At the conclusion of the procedure, there were multiphasic Doppler signals throughout the graft. The procedure was well tolerated, and the patient had an uneventful course with no neurologic sequelae. Conclusions: To our knowledge, this is the first case reported of tumor invasion of the internal carotid reconstructed using Artegraft bovine heterograft as conduit. This novel approach provides an alternative to synthetic conduit when there is an increased concern for infection and need for a durable repair in a patient without suitable autologous conduit. Author Disclosures: E. B. Trestman: None; P. De Los Santos: None; E. Garfein: None; T. Ow: None; E. C. Lipsitz: None; S. Shariff: None. Outcomes for Carotid Blowout Interventions in Patients With Head and Neck Cancer Nathan L. Liang, MD1, Brian D. Guedes, BS2, Umamaheswar Duvvuri, MD1, Michael J. Singh, MD1, Rabih A. Chaer, MD, MSc1, Michel S. Makaroun, MD1, Ulka Sachdev, MD1. 1University of Pittsburgh Medical Center, Pittsburgh, Pa; 2University of Pittsburgh, Pittsburgh, Pa Objectives: The purpose of this study was to examine the characteristics and outcomes of a patient cohort undergoing intervention for carotid blowout syndrome (CBS) associated with head and neck cancer. Methods: Patients with head and neck cancer who presented with carotid-distribution bleeding from 2000 to 2014 were identified in the medical record. Standard statistical methods and survival analysis were used to analyze study population characteristics and outcomes. Results: The study included 37 patients (74% male). The mean age was 60.1 6 11.4 years. All malignancies were squamous cell type, stage IV, in a variety of primary locations: 32% oral cavity, 24% larynx, 16% superficial neck, with the remainder in the oropharynx, nasopharynx, and hypopharynx. Fifty-one percent of hemorrhages were common carotid, 29% were external carotid, and 19% were internal carotid distribution. Sixty-eight percent presented with acute hemorrhage, 24% with impending, and 8% with threatened hemorrhage. All patients underwent intervention: 38% received endovascular coil embolization, 30% stent grafts, 22% surgical ligation, and 10% primary vessel repair or bypass grafting. Complications included perioperative stroke in 10.8% of patients; other major complications were rare. Estimated recurrent bleeding risk was 24% at 30 days and 34% at 6 months. Prior neck dissection was the only significant factor associated with recurrent bleeding. Most patients (91.9%) survived to hospital discharge. The 90-day and 1-year estimated survival was 60.9% and 36.6%, respectively. Conclusions: CBS associated with head and neck cancer carries poor midterm and long-term prognoses; however, mortality may be related more to the advanced stage of disease rather than carotid involvement or associated intervention. Surgical and endovascular approaches may both be efficacious in cases of acute hemorrhage but carry a significant risk of periprocedural stroke.
Table. Limb salvage after infrainguinal bypass in patients on hemodialysis Limb salvage White % (95% CI) Black % (95% CI) Hispanic % (95% CI) 1 2 3 4
year years years years
69.1 60.2 53.6 47.8
(67.8-70.4) (58.6-61.8) (51.7-55.5) (45.3-50.3)
61.2 51.9 45.6 40.7
(59.5-62.8) (50.0-53.7) (43.6-47.7) (38.3-43.1)
62.3 54.5 46.7 38.1
(58.7-65.8) (50.5-58.4) (42.2-51.5) (31.7-44.6)
CI, Confidence interval. Kaplan-Meier and multivariate Cox regression analyses adjusting for patient characteristics were used to evaluate long-term limb salvage. Results: There were 12,491 infrainguinal OBSs placed in this cohort with a mean follow-up of 1.4 (standard deviation, 1.32) years. The mean age was 63 (standard deviation, 12.2) years and 62% of patients were male, and 54% were white vs 35% black, 7% Hispanic, and 4% others. Overall, 30-day perioperative graft failure and death rates were 7.7% and 7.5%, respectively. Limb salvage was 66% at 1 year, 57% at 2 years, 51% at 3 years, and 45% at 4 years (Table). The significant predictors of long-term limb loss were male gender (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.05-1.26; P < .05), black race (HR, 1.32; 95% CI, 1.19-1.46; P < .001), and immobility (HR, 1.31; 95% CI, 1.11-1.55; P < .001). Conclusions: This is the largest study to date to evaluate the longterm outcomes of limb salvage in patients on HD. This study confirms overall worse outcomes in this population and highlights the racial disparity in limb salvage after revascularization. Author Disclosures: M. B. Malas: None; I. J. Arhuidese: None; T. Obeid: None; C. W. Hicks: None; U. Qazi: None; D. Segev: None. Carotid-Carotid-Subclavian Artery Bypass for Ruptured Mycotic Pseudoaneurysm of Innominate Artery Ratna C. Medicherla, MD, Jennifer Stableford, MD, Saadat Shariff, MD, Pablo de los Santos, MD, Richard Smith, MD, William Jakobleff Jr, MD, Joseph Derose, MD, Evan Lipsitz, MD, Jeffrey Kirk, MD. Montefiore Medical Center, Bronx, NY Objectives: Mycotic pseudoaneurysms of the innominate artery (PAIA) are a rare entity. We report a patient with a symptomatic PAIA
Author Disclosures: N. L. Liang: None; B. D. Guedes: None; U. Duvvuri: None; M. J. Singh: None; R. A. Chaer: None; M. S. Makaroun: None; U. Sachdev: None. Racial Disparity in Limb Salvage Following Revascularization in Patients on Hemodialysis Mahmoud B. Malas, MD, MHS, Isibor J. Arhuidese, MD, MPH, Tammam Obeid, MD, Caitlin W. Hicks, MD, MS, Umair Qazi, MD, MPH, Dorry Segev, MD, PhD. Johns Hopkins Medical Institutions, Baltimore, Md Objectives: Prior reports of outcomes after infrainguinal open bypass surgery (OBS) in patients with end-stage renal disease (ESRD) on hemodialysis (HD) have been based on small-sample institutional series. In addition, race is known to have a marked impact on outcomes in the HD population. In this study, we evaluate the effects of race on long-term OBS outcomes from a nationally representative cohort of HD patients. Methods: We studied all HD patients who underwent infrainguinal OBS in the United States Renal Disease System database between January 2006 and December 2011. Univariate methods (c2, analysis of variance) were used to compare patients’ demographic and medical characteristics.
Fig. Innominate artery pseudoaneurysm (IAPA).