{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T22:44:07Z","timestamp":1781995447371,"version":"3.54.5"},"reference-count":54,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:00:00Z","timestamp":1663286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devices are now available for physicians. However, in order to obtain a high success rate, it is necessary to respect an algorithm whose choice of device is only one step in the treatment. Materials and Methods: The first step is, therefore, to define the approach according to the lesion to be treated. Anterograde approaches (femoral, radial, or humeral) are distinguished from retrograde approaches depending on the patient\u2019s anatomy and surgical history. Secondarily, the lesion will be crossed intraluminally or subintimally using a catheter or an angioplasty balloon. The third step corresponds to the preparation of the artery, which is essential before the implantation of the device. It has a crucial role in reducing the rate of restenosis. Several tools are available and are chosen according to the lesion requiring treatment (stenosis, occlusion). Among them, we find the angioplasty balloon, the atherectomy probes, or intravascular lithotripsy. Finally, the last step corresponds to the choice of the device to be implanted. This is also based on the nature of the lesion, which is considered short, up to 15 cm and complex beyond that. The choice of device will be between bare stents, covered stents, drug-coated balloons, and drug-eluting stents. Currently, drug-eluting stents appear to be the treatment of choice for short lesions, and active devices seem to be the preferred treatment for more complex lesions, although there is a lack of data. Results: In case of failure to cross the lesion, the retrograde approach is a safe and effective alternative. Balloon angioplasty currently remains the reference method for the preparation of the artery, the aim of which is to ensure the intraoperative technical success of the treatment (residual stenosis &lt; 30%), to limit the risk of dissection and, finally, to limit the occurrence of restenosis. Concerning the treatment, the drug-eluting devices seem to present the best results, whether for simple or complex lesions. Conclusions: Endovascular treatment for femoropopliteal lesions needs to be considered upstream of the intervention in order to anticipate the treatment and the choice of devices for each stage.<\/jats:p>","DOI":"10.3390\/medicina58091293","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T02:06:50Z","timestamp":1663553210000},"page":"1293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Algorithm of Femoropopliteal Endovascular Treatment"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5457-8807","authenticated-orcid":false,"given":"Maxime","family":"Dubosq","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Institut C\u0153ur-Poumon, 59000 Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Raux","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Groupe hospitalier Paris St Joseph, 75014 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahaa","family":"Nasr","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Brest University Hospital, 29200 Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yann","family":"Gou\u00ebffic","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Groupe hospitalier Paris St Joseph, 75014 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.5603\/KP.2017.0216","article-title":"2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)","volume":"75","author":"Aboyans","year":"2017","journal-title":"Kardiol. Pol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jvs.2009.01.035","article-title":"National trends in lower extremity bypass surgery, endovascular interventions, and major amputations","volume":"50","author":"Goodney","year":"2009","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.jvs.2006.12.037","article-title":"Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)","volume":"45","author":"Norgren","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Fukuda, K., Okazaki, S., Shiozaki, M., Okai, I., Nishino, A., Tamura, H., Inoue, K., Sumiyoshi, M., Daida, H., and Minamino, T. (2021). Ultrasound-guided puncture reduces bleeding-associated complications, regardless of calcified plaque, after endovascular treatment of femoropopliteal lesions, especially using the antegrade procedure: A single-center study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0248416"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1007\/s00270-003-2721-y","article-title":"Retrograde vs. antegrade puncture for infra-inguinal angioplasty","volume":"26","author":"Nice","year":"2003","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.avsg.2021.06.012","article-title":"Antegrade Superficial Femoral Artery Approach Using Manual Compression and 4-F Delivery System for Infrainguinal Occlusive Disease","volume":"78","author":"Nasr","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1177\/1526602817753388","article-title":"Precise Retrograde Supera Stenting of the Ostium (PRESTO) of the Superficial Femoral Artery for Complex Femoropopliteal Occlusions: The PRESTO Technique","volume":"25","author":"Palena","year":"2018","journal-title":"J. Endovasc. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.jvs.2014.07.009","article-title":"Percutaneous radial access for peripheral transluminal angioplasty","volume":"61","author":"Coscas","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/j.jvs.2020.08.143","article-title":"Percutaneous brachial access associated with increased incidence of complications compared with open exposure for peripheral vascular interventions in a contemporary series","volume":"73","author":"DeCarlo","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.avsg.2015.10.027","article-title":"Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access","volume":"33","author":"Nasr","year":"2016","journal-title":"Ann. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.carrev.2019.10.023","article-title":"Primary Retrograde Tibio-Pedal Approach for Endovascular Intervention of Femoropopliteal Disease with Chronic Total Occlusion","volume":"21","author":"Htun","year":"2020","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.jvir.2018.08.030","article-title":"Primary Retrograde Dorsalis Pedis Artery Single Access for Revascularization of Chronic Total Occlusion in Patients with Critical Limb Ischemia","volume":"30","author":"Raskin","year":"2019","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1177\/1526602816666261","article-title":"Comparable 2-Year Restenosis Rates Following Subintimal and Intraluminal Drug-Eluting Stent Implantation for Femoropopliteal Chronic Total Occlusion","volume":"23","author":"Ishihara","year":"2016","journal-title":"J. Endovasc. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.jcin.2013.01.128","article-title":"2-year results of paclitaxel-eluting balloons for femoropopliteal artery disease: Evidence from a multicenter registry","volume":"6","author":"Micari","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.jcin.2015.12.267","article-title":"Drug-Coated Balloons for Complex Femoropopliteal Lesions: 2-Year Results of a Real-World Registry","volume":"9","author":"Schmidt","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1016\/j.jvs.2013.05.107","article-title":"Initial and 3-year results after subintimal versus intraluminal approach for long femoropopliteal occlusion treated with a self-expandable nitinol stent","volume":"58","author":"Soga","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.ejvs.2020.11.020","article-title":"Technical Success and Complication Rates of Retrograde Arterial Access for Endovascular Therapy for Critical Limb Ischaemia: A Systematic Review and Meta-Analysis","volume":"61","author":"Giannopoulos","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.jvs.2021.09.022","article-title":"Technical perspectives in the management of complex infrainguinal arterial chronic total occlusions","volume":"75","author":"Solimeno","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.jvs.2014.02.038","article-title":"Retrograde pedal access for patients with critical limb ischemia","volume":"60","author":"Bazan","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.ejvs.2008.06.020","article-title":"Clinical Endpoints in Peripheral Endovascular Revascularization Trials: A Case for Standardized Definitions","volume":"36","author":"Diehm","year":"2008","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1161\/CIRCULATIONAHA.115.016900","article-title":"Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial","volume":"133","author":"Dake","year":"2016","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/S1051-0443(07)61736-9","article-title":"Peripheral Arterial Balloon Angioplasty: Effect of Short versus Long Balloon Inflation Times on the Morphologic Results","volume":"13","author":"Zorger","year":"2002","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1177\/1526602817698634","article-title":"Angiographic Dissection Patterns and Patency Outcomes after Balloon Angioplasty for Superficial Femoral Artery Disease","volume":"24","author":"Fujihara","year":"2017","journal-title":"J. Endovasc. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/1526602817710770","article-title":"Six-Month Results from the Initial Randomized Study of the Ranger Paclitaxel-Coated Balloon in the Femoropopliteal Segment","volume":"24","author":"Bausback","year":"2017","journal-title":"J. Endovasc. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.jvs.2019.01.080","article-title":"Systematic review and updated meta-analysis of the use of drug-coated balloon angioplasty versus plain old balloon angioplasty for femoropopliteal arterial disease","volume":"70","author":"Caradu","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.jcin.2013.07.010","article-title":"Drug-eluting balloon in peripheral intervention for the superficial femoral artery: The DEBATE-SFA randomized trial (drug eluting balloon in peripheral intervention for the superficial femoral artery)","volume":"6","author":"Liistro","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.jcin.2017.01.028","article-title":"2-Year Results of Paclitaxel-Coated Balloons for Long Femoropopliteal Artery Disease: Evidence From the SFA-Long Study","volume":"10","author":"Micari","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.jcin.2018.01.276","article-title":"12-Month Results From the First-in-Human Randomized Study of the Ranger Paclitaxel-Coated Balloon for Femoropopliteal Treatment","volume":"11","author":"Steiner","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e004848","DOI":"10.1161\/CIRCINTERVENTIONS.116.004848","article-title":"Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study","volume":"10","author":"Zeller","year":"2017","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_30","first-page":"355","article-title":"The COMPLIANCE 360\u00b0 Trial: A randomized, prospective, multicenter, pilot study comparing acute and long-term results of orbital atherectomy to balloon angioplasty for calcified femoropopliteal disease","volume":"26","author":"Dattilo","year":"2014","journal-title":"J. Invasive Cardiol."},{"key":"ref_31","first-page":"1352","article-title":"Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes from the Randomized Disrupt PAD III Trial","volume":"14","author":"Tepe","year":"2021","journal-title":"Cardiovasc. Interv."},{"key":"ref_32","first-page":"100341","article-title":"Intravascular lithotripsy for peripheral artery calcification: Mid-term outcomes from the randomized Disrupt PAD III trial","volume":"1","author":"Tepe","year":"2022","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1177\/1526602820902014","article-title":"ZILVERPASS Study: ZILVER PTX Stent vs Bypass Surgery in Femoropopliteal Lesions","volume":"27","author":"Bosiers","year":"2020","journal-title":"J. Endovasc. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2541","DOI":"10.1016\/j.jcin.2019.09.006","article-title":"Nitinol Stent Versus Bypass in Long Femoropopliteal Lesions: 2-Year Results of a Randomized Controlled Trial","volume":"12","author":"Enzmann","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2320","DOI":"10.1016\/j.jcin.2017.09.013","article-title":"1-Year Results of a Multicenter Randomized Controlled Trial Comparing Heparin-Bonded Endoluminal to Femoropopliteal Bypass","volume":"10","author":"Reijnen","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1067\/mva.2003.155","article-title":"Systematic versus selective stent placement after superficial femoral artery balloon angioplasty: A multicenter prospective randomized study","volume":"37","author":"Becquemin","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1002\/ccd.22128","article-title":"Balloon angioplasty versus stenting with nitinol stents in intermediate length superficial femoral artery lesions","volume":"74","author":"Dick","year":"2009","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1583\/11-3627.1","article-title":"Nitinol stent implantation vs. balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication: Three-year follow-up from the RESILIENT randomized trial","volume":"19","author":"Laird","year":"2012","journal-title":"J. Endovasc. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1056\/NEJMoa051303","article-title":"Balloon Angioplasty versus Implantation of Nitinol Stents in the Superficial Femoral Artery","volume":"354","author":"Schillinger","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.jcin.2019.12.028","article-title":"A Polymer-Free Paclitaxel-Eluting Stent Versus a Bare-Metal Stent for De Novo Femoropopliteal Lesions: The BATTLE Trial","volume":"13","author":"Sauguet","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/S0140-6736(18)32262-1","article-title":"A polymer-coated, paclitaxel-eluting stent (Eluvia) versus a polymer-free, paclitaxel-coated stent (Zilver PTX) for endovascular femoropopliteal intervention (IMPERIAL): A randomised, non-inferiority trial","volume":"392","author":"Gray","year":"2018","journal-title":"Lancet"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.eclinm.2019.09.004","article-title":"Benefit and risk from paclitaxel-coated balloon angioplasty for the treatment of femoropopliteal artery disease: A systematic review and meta-analysis of randomised controlled trials","volume":"16","author":"Klumb","year":"2019","journal-title":"eClinicalMedicine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1016\/j.jvs.2020.10.075","article-title":"Network meta-analysis of drug-coated balloon angioplasty versus primary nitinol stenting for femoropopliteal atherosclerotic disease","volume":"73","author":"Abdoli","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.jacc.2018.11.039","article-title":"Drug-Eluting Stent Versus Drug-Coated Balloon Revascularization in Patients with Femoropopliteal Arterial Disease","volume":"73","author":"Bausback","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.jacc.2019.04.057","article-title":"Drug-Eluting Balloon versus Drug-Eluting Stent for Complex Femoropopliteal Arterial Lesions: The DRASTICO Study","volume":"74","author":"Liistro","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.jcin.2021.12.034","article-title":"2-Year Results with a Sirolimus-Eluting Self-Expanding Stent for Femoropopliteal Lesions: The First-in-Human ILLUMINA Study","volume":"15","author":"Steiner","year":"2022","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1177\/1526602820941811","article-title":"Six-Month Outcomes from the First-in-Human, Single-Arm SELUTION Sustained-Limus-Release Drug-Eluting Balloon Trial in Femoropopliteal Lesions","volume":"27","author":"Zeller","year":"2020","journal-title":"J. Endovasc. Ther."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e011245","DOI":"10.1161\/JAHA.118.011245","article-title":"Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"7","author":"Katsanos","year":"2018","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1177\/1526602820941800","article-title":"Fragility of the Signal","volume":"27","author":"Goueffic","year":"2020","journal-title":"J. Endovasc. Ther."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.ejvs.2019.12.034","article-title":"Editor\u2019s Choice\u2014Long Term Survival after Femoropopliteal Artery Revascularisation with Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis","volume":"59","author":"Behrendt","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3732","DOI":"10.1093\/eurheartj\/ehz698","article-title":"Mortality after use of paclitaxel-based devices in peripheral arteries: A real-world safety analysis","volume":"41","author":"Freisinger","year":"2020","journal-title":"Eur. Hear. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/j.jacc.2019.02.020","article-title":"Drug-Eluting Stent Implantation and Long-Term Survival Following Peripheral Artery Revascularization","volume":"73","author":"Secemsky","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1016\/j.jacc.2021.08.052","article-title":"Safety and Effectiveness of Paclitaxel Drug-Coated Devices in Peripheral Artery Revascularization: Insights From VOYAGER PAD","volume":"78","author":"Hess","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2538","DOI":"10.1056\/NEJMoa2005206","article-title":"Mortality with Paclitaxel-Coated Devices in Peripheral Artery Disease","volume":"383","author":"Nordanstig","year":"2020","journal-title":"N. Engl. J. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1293\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:32:53Z","timestamp":1760142773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,16]]},"references-count":54,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["medicina58091293"],"URL":"https:\/\/doi.org\/10.3390\/medicina58091293","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,16]]}}}