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Endovascular intervention for renal artery stenosis

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Abstract

Renovascular diseases are common conditions with important implications on cardiovascular morbidity and mortality. Renal artery stenosis (RAS) is present in 1–5% of patients with hypertension (HTN) in the US with the vast majority of caused by atherosclerosis. Atheroscelortic RAS is related not only to uncontrolled HTN, but also to renal dysfunction. Atherosclerotic RAS in the USA has been reported to account for approximately 14–16% of new patients requiring dialysis each year. Hence a concerted effort was made in the last decade to treat renovascular stenosis using newly developed endovascular therapies to improve cardiovascular morbidity and renal function. A review on new advances in the endovascular management of renal artery stenosis with low profile stents, embolic protection devices, and drug eluting stents is presented.

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References

  1. Conlon PJ, Little MA, Pieper K, Mark DB (2001) Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography. Kidney Int 60(4):1490–1497

    Article  CAS  PubMed  Google Scholar 

  2. Isles C, Main J, O’Connell J, et al. (1990) Survival associated with renovascular disease in Glasgow and Newcastle: a collaborative study. Scott Med J 35(3):70–73

    CAS  PubMed  Google Scholar 

  3. Sivamurthy N, Surowiec SM, Culakova E, et al. (2004) Divergent outcomes after percutaneous therapy for symptomatic renal artery stenosis. J Vasc Surg 39(3):565–574

    Article  PubMed  Google Scholar 

  4. Rocha-Singh KJ, Ahuja RK, Sung C-H, Rutherford J (2002) Long-term renal function preservation after renal artery stenting in patients with progressive ischemic nephropathy. Catheter Cardiovasc Intervent 57(2):135–141

    Article  Google Scholar 

  5. Ram CV (1997) Renovascular hypertension. Curr Opin Nephrol Hypertens 6(6):575–579

    Article  CAS  PubMed  Google Scholar 

  6. Derkx FH, Schalekamp MA (1994) Renal artery stenosis and hypertension. Lancet 344(8917):237–239

    Article  CAS  PubMed  Google Scholar 

  7. Vokonas PS, Kannel WB, Cupples LA (1988) Epidemiology and risk of hypertension in the elderly: the Framingham Study. J Hypertens Suppl 6(1):S3–S9

    CAS  PubMed  Google Scholar 

  8. Hansen KJ, Edwards MS, Craven TE, et al. (2002) Prevalence of renovascular disease in the elderly: a population-based study. J Vasc Surg 36(3):443–451

    Article  PubMed  Google Scholar 

  9. Harding MB, Smith LR, Himmelstein SI, et al. (1992) Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization. J Am Soc Nephrol 2(11):1608–1616

    CAS  PubMed  Google Scholar 

  10. Miralles M, Corominas A, Cotillas J, et al. (1998) Screening for carotid and renal artery stenoses in patients with aortoiliac disease. Ann Vasc Surg 12(1):17–22

    Article  CAS  PubMed  Google Scholar 

  11. Swartbol P, Parsson H, Thorvinger B, Norgren L (1994) To what extent does peripheral vascular disease and hypertension predict renal artery stenosis? Int Angiol 13(2):109–114

    CAS  PubMed  Google Scholar 

  12. Zierler RE, Bergelin RO, Davidson RC, et al. (1996) A prospective study of disease progression in patients with atherosclerotic renal artery stenosis. Am J Hypertens 9(11):1055–1061

    Article  CAS  PubMed  Google Scholar 

  13. Caps MT, Perissinotto C, Zierler RE, et al. (1998) Prospective study of atherosclerotic disease progression in the renal artery. Circulation 98(25):2866–2872

    CAS  PubMed  Google Scholar 

  14. Schreiber MJ, Pohl MA, Novick AC (1984) The natural history of atherosclerotic and fibrous renal artery disease. Urol Clin North Am 11(3):383–392

    CAS  PubMed  Google Scholar 

  15. Guzman RP, Zierler RE, Isaacson JA, Bergelin RO, Strandness DE Jr (1994) Renal atrophy and arterial stenosis. A prospective study with duplex ultrasound. Hypertension 23(3):346–350

    CAS  PubMed  Google Scholar 

  16. Connolly JO, Higgins RM, Walters HL, et al. (1994) Presentation, clinical features and outcome in different patterns of atherosclerotic renovascular disease. QJM 87(7):413–421

    CAS  PubMed  Google Scholar 

  17. Coen G, Calabria S, Lai S, et al. (2003) Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population. BMC Nephrol 4:2

    Article  PubMed  Google Scholar 

  18. Guo H, Kalra PA, Gilbertson DT, et al. (2007) Atherosclerotic renovascular disease in older US patients starting dialysis, 1996 to 2001. Circulation 115(1):50–58

    Article  PubMed  Google Scholar 

  19. Mailloux LU, Napolitano B, Bellucci AG, et al. (1994) Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: a 20-year clinical experience. Am J Kidney Dis 24(4):622–629

    CAS  PubMed  Google Scholar 

  20. Baumgartner I, Behrendt P, Rohner P, Baumgartner RW (1999) A validation study on the intraobserver and interobserver reproducibility of renal artery duplex ultrasound. Ultrasound Med Biol 25(2):225–231

    Article  CAS  PubMed  Google Scholar 

  21. Radermacher J, Chavan A, Schaffer J, et al. (2000) Detection of significant renal artery stenosis with color Doppler sonography: combining extrarenal and intrarenal approaches to minimize technical failure. Clin Nephrol 53(5):333–343

    CAS  PubMed  Google Scholar 

  22. Soares GM, Murphy TP, Singha MS, Parada A, Jaff M (2006) Renal artery duplex ultrasonography as a screening and surveillance tool to detect renal artery stenosis: a comparison with current reference standard imaging. J Ultrasound Med 25(3):293–298

    PubMed  Google Scholar 

  23. Radermacher J, Chavan A, Bleck J, et al. (2001) Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 344(6):410–417

    Article  CAS  PubMed  Google Scholar 

  24. Zeller T, Frank U, Muller C, et al. (2003) Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis. Circulation 108(18):2244–2249

    Article  PubMed  Google Scholar 

  25. Zeller T, Muller C, Frank U, et al. (2003) Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis. Catheter Cardiovasc Intervent 58(4):510–515

    Article  Google Scholar 

  26. Vasbinder GB, Nelemans PJ, Kessels AG, et al. (2001) Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med 135(6):401–411

    CAS  PubMed  Google Scholar 

  27. Eklof H, Ahlstrom H, Magnusson A, et al. (2006) A prospective comparison of duplex ultrasonography, captopril renography, MRA, and CTA in assessing renal artery stenosis. Acta Radiol 47(8):764–774

    Article  CAS  PubMed  Google Scholar 

  28. Leiner T, de Haan MW, Nelemans PJ, van Engelshoven JMA, Vasbinder GBC (2005) Contemporary imaging techniques for the diagnosis of renal artery stenosis. Eur Radiol 15(11):2219–2229

    Article  CAS  PubMed  Google Scholar 

  29. Tan KT, van Beek EJR, Brown PWG, et al. (2002) Magnetic resonance angiography for the diagnosis of renal artery stenosis: a meta-analysis. Clin Radiol 57(7):617–624

    Article  CAS  PubMed  Google Scholar 

  30. Textor SC, Glockner JF, Lerman LO, et al. (2008) The use of magnetic resonance to evaluate tissue oxygenation in renal artery stenosis. J Am Soc Nephrol 19(4):780–788

    Article  PubMed  Google Scholar 

  31. Bongers V, Bakker J, Beutler JJ, Beek FJ, De Klerk JM (2000) Assessment of renal artery stenosis: comparison of captopril renography and gadolinium-enhanced breath-hold MR angiography. Clin Radiol 55(5):346–353

    Article  CAS  PubMed  Google Scholar 

  32. Rossi GP, Cesari M, Chiesura-Corona M, et al. (2002) Renal vein renin measurements accurately identify renovascular hypertension caused by total occlusion of the renal artery. J Hypertens 20(5):975–984

    Article  CAS  PubMed  Google Scholar 

  33. Sato K, Abe K, Seino M, et al. (1988) Renal vein plasma renin activity in patients with unilateral renovascular hypertension. Jpn Circ J 52(5):431–436

    CAS  PubMed  Google Scholar 

  34. Gruntzig A, Kuhlmann U, Vetter W, et al. (1978) Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal-artery stenosis. Lancet 1(8068):801–802

    Article  CAS  PubMed  Google Scholar 

  35. Palmaz JC, Kopp DT, Hayashi H, et al. (1987) Normal and stenotic renal arteries: experimental balloon-expandable intraluminal stenting. Radiology 164(3):705–708

    CAS  PubMed  Google Scholar 

  36. Hoffman O, Carreres T, Sapoval MR, et al. (1998) Ostial renal artery stenosis angioplasty: immediate and mid-term angiographic and clinical results. J Vasc Interv Radiol 9(1 Pt 1):65–73

    Article  CAS  PubMed  Google Scholar 

  37. Grim CE, Luft FC, Yune HY, Klatte EC, Weinberger MH (1981) Percutaneous transluminal dilatation in the treatment of renal vascular hypertension. Ann Intern Med 95(4):439–442

    CAS  PubMed  Google Scholar 

  38. Tuttle KR, Chouinard RF, Webber JT, et al. (1998) Treatment of atherosclerotic ostial renal artery stenosis with the intravascular stent. Am J Kidney Dis 32(4):611–622

    Article  CAS  PubMed  Google Scholar 

  39. Leertouwer TC, Gussenhoven EJ, Bosch JL, et al. (2000) Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology 216(1):78–85

    CAS  PubMed  Google Scholar 

  40. Ramos F, Kotliar C, Alvarez D, et al. (2003) Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis. Kidney Int 63(1):276–282

    Article  PubMed  Google Scholar 

  41. Hirsch AT, Haskal ZJ, Hertzer NR, et al. (2006) ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 113(11):e463–e654

    Article  PubMed  Google Scholar 

  42. Dorros G, Jaff M, Jain A, Dufek C, Mathiak L (1995) Follow-up of primary Palmaz-Schatz stent placement for atherosclerotic renal artery stenosis. Am J Cardiol 75(15):1051–1055

    Article  CAS  PubMed  Google Scholar 

  43. Blum U, Krumme B, Flugel P, et al. (1997) Treatment of ostial renal-artery stenoses with vascular endoprostheses after unsuccessful balloon angioplasty. N Engl J Med 336(7):459–465

    Article  CAS  PubMed  Google Scholar 

  44. Lederman RJ, Mendelsohn FO, Santos R, et al. (2001) Primary renal artery stenting: characteristics and outcomes after 363 procedures. Am Heart J 142(2):314–323

    Article  CAS  PubMed  Google Scholar 

  45. White CJ, Ramee SR, Collins TJ, et al. (1997) Renal artery stent placement: utility in lesions difficult to treat with balloon angioplasty. J Am Coll Cardiol 30(6):1445–1450

    Article  CAS  PubMed  Google Scholar 

  46. Rundback JH, Sacks D, Kent KC, et al. (2002) Guidelines for the reporting of renal artery revascularization in clinical trials. J Vasc Interv Radiol 13(10):959–974

    Article  PubMed  Google Scholar 

  47. Scolari F, Bracchi M, Valzorio B, et al. (1996) Cholesterol atheromatous embolism: an increasingly recognized cause of acute renal failure. Nephrol Dial Transplant 11(8):1607–1612

    CAS  PubMed  Google Scholar 

  48. Meyrier A (1996) Renal vascular lesions in the elderly: nephrosclerosis or atheromatous renal disease? Nephrol Dial Transplant 11 Suppl 9:45–52

    CAS  PubMed  Google Scholar 

  49. Martin EC, Mattern RF, Baer L, Fankuchen EI, Casarella WJ (1981) Renal angioplasty for hypertension: predictive factors for long-term success. AJR Am J Roentgenol 137(5):921–924

    CAS  PubMed  Google Scholar 

  50. Krishnamurthi V, Novick AC, Myles JL (1999) Atheroembolic renal disease: effect on morbidity and survival after revascularization for atherosclerotic renal artery stenosis. J Urol 161(4):1093–1096

    Article  CAS  PubMed  Google Scholar 

  51. Kastrup A, Groschel K, Krapf H, et al. (2003) Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 34(3):813–819

    Article  PubMed  Google Scholar 

  52. Stone GW, Rogers C, Hermiller J, et al. (2003) Randomized comparison of distal protection with a filter-based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto-coronary bypass grafts. Circulation 108(5):548–553

    Article  PubMed  Google Scholar 

  53. Sheps SG, Kincaid OW, Hunt JC (1972) Serial renal function and angiographic observations in idiopathic fibrous and fibromuscular stenoses of the renal arteries. Am J Cardiol 30(1):55–60

    Article  CAS  PubMed  Google Scholar 

  54. Thatipelli MR, Sabater EA, Bjarnason H, McKusick MA, Misra S (2007) CT angiography of renal artery anatomy for evaluating embolic protection devices. J Vasc Interv Radiol 18(7):842–846

    Article  PubMed  Google Scholar 

  55. Goncharenko V, Gerlock AJJr, Shaff MI, Hollifield JW (1981) Progression of renal artery fibromuscular dysplasia in 42 patients as seen on angiography. Radiology 139(1):45–51

    CAS  PubMed  Google Scholar 

  56. Edwards MS, Craven BL, Stafford J, et al. (2006) Distal embolic protection during renal artery angioplasty and stenting. J Vasc Surg 44(1):128–135

    Article  PubMed  Google Scholar 

  57. Thatipelli MR, Misra S, Sanikommu SR, et al. (2009) Embolic protection device use in renal artery stent placement. J Vasc Interv Radiol 20(5):580–586

    Article  PubMed  Google Scholar 

  58. Holden A, Hill A, Jaff MR, Pilmore H (2006) Renal artery stent revascularization with embolic protection in patients with ischemic nephropathy. Kidney Int 70(5):948–955

    Article  CAS  PubMed  Google Scholar 

  59. Hagspiel KD, Stone JR, Leung DA (2005) Renal angioplasty and stent placement with distal protection: preliminary experience with the FilterWire EX. J Vasc Interv Radiol 16(1):125–131

    PubMed  Google Scholar 

  60. van Jaarsveld BC, Krijnen P, Pieterman H, et al. (2000) The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group. N Engl J Med 342(14):1007–1014

    Article  PubMed  Google Scholar 

  61. Plouin PF, Chatellier G, Darne B, Raynaud A (1998) Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group. Hypertension 31(3):823–829

    CAS  PubMed  Google Scholar 

  62. Webster J, Marshall F, Abdalla M, et al. (1998) Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group. J Hum Hypertens 12(5):329–335

    Article  CAS  PubMed  Google Scholar 

  63. Barri YM, Davidson RA, Senler S, et al. (1996) Prediction of cure of hypertension in atherosclerotic renal artery stenosis. South Med J 89(7):679–683

    CAS  PubMed  Google Scholar 

  64. Subramanian R, White CJ, Rosenfield K, et al. (2005) Renal fractional flow reserve: a hemodynamic evaluation of moderate renal artery stenoses. Catheter Cardiovasc Intervent 64(4):480–486

    Article  Google Scholar 

  65. Silva JA, Chan AW, White CJ, et al. (2005) Elevated brain natriuretic peptide predicts blood pressure response after stent revascularization in patients with renal artery stenosis. Circulation 111(3):328–333

    Article  CAS  PubMed  Google Scholar 

  66. Gill KS, Fowler RC (2003) Atherosclerotic renal arterial stenosis: clinical outcomes of stent placement for hypertension and renal failure. Radiology 226(3):821–826

    Article  PubMed  Google Scholar 

  67. Taylor A, Sheppard D, Macleod MJ, et al. (1997) Renal artery stent placement in renal artery stenosis: technical and early clinical results. Clin Radiol 52(6):451–457

    Article  CAS  PubMed  Google Scholar 

  68. Harden PN, MacLeod MJ, Rodger RS, et al. (1997) Effect of renal-artery stenting on progression of renovascular renal failure. Lancet 349(9059):1133–1136

    Article  CAS  PubMed  Google Scholar 

  69. Dorros G, Jaff M, Mathiak L, et al. (1998) Four-year follow-up of Palmaz-Schatz stent revascularization as treatment for atherosclerotic renal artery stenosis. Circulation 98(7):642–647

    CAS  PubMed  Google Scholar 

  70. Hansen KJ, Cherr GS, Craven TE, et al. (2000) Management of ischemic nephropathy: dialysis-free survival after surgical repair. J Vasc Surg 32(3):472–481 (discussion 481–482)

    Article  CAS  PubMed  Google Scholar 

  71. Korsakas S, Mohaupt MG, Dinkel HP, et al. (2004) Delay of dialysis in end-stage renal failure: prospective study on percutaneous renal artery interventions. Kidney Int 65(1):251–258

    Article  CAS  PubMed  Google Scholar 

  72. Safian RD, Textor SC (2001) Renal-artery stenosis. N Engl J Med 344(6):431–442

    Article  CAS  PubMed  Google Scholar 

  73. Butler A, Eagleton M, Wang D, et al. (1991) Induction of the proliferative phenotype in differentiated myogenic cells by hypoxia. J Biol Chem 266(27):18250–18258

    CAS  PubMed  Google Scholar 

  74. Hansen KJ (1994) Prevalence of ischemic nephropathy in the atherosclerotic population. Am J Kidney Dis 24(4):615–621

    CAS  PubMed  Google Scholar 

  75. Greco BA, Breyer JA (1996) The natural history of renal artery stenosis: who should be evaluated for suspected ischemic nephropathy? Semin Nephrol 16(1):2–11

    CAS  PubMed  Google Scholar 

  76. Collins AJ, Foley R, Herzog C, et al. (2008) Excerpts from the United States Renal Data System 2007 annual data report. Am J Kidney Dis 51(1 Suppl 1):S1–S320

    Google Scholar 

  77. Thatipelli M, Misra S, Johnson CM, et al. (2008) Renal artery stent placement for restoration of renal function in hemodialysis recipients with renal artery stenosis. J Vasc Interv Radiol 19(11):1563–1568

    Article  PubMed  Google Scholar 

  78. Diamond JR (1993) Flash pulmonary edema and the diagnostic suspicion of occult renal artery stenosis. Am J Kidney Dis 21(3):328–330

    CAS  PubMed  Google Scholar 

  79. Tami LF, McElderry MW, al-Adli NM, Rubin M, Condos WR (1995) Renal artery stenosis presenting as crescendo angina pectoris. Cathet Cardiovasc Diagn 35(3):252–256

    Article  CAS  PubMed  Google Scholar 

  80. Gray BH, Olin JW, Childs MB, Sullivan TM, Bacharach JM (2002) Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure. Vasc Med 7(4):275–279

    Article  PubMed  Google Scholar 

  81. Pickering TG, Herman L, Devereux RB, et al. (1988) Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet 2(8610):551–552

    Article  CAS  PubMed  Google Scholar 

  82. Messina LM, Zelenock GB, Yao KA, Stanley JC (1992) Renal revascularization for recurrent pulmonary edema in patients with poorly controlled hypertension and renal insufficiency: a distinct subgroup of patients with arteriosclerotic renal artery occlusive disease. J Vasc Surg 15(1):73–80 (discussion 80–82)

    Article  CAS  PubMed  Google Scholar 

  83. Eggers PW, Connerton R, McMullan M (1984) The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival. Health Care Financing Rev 5(3):69–88

    CAS  Google Scholar 

  84. Kalra PA, Guo H, Kausz AT, et al. (2005) Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis. Kidney Int 68(1):293–301

    Article  PubMed  Google Scholar 

  85. Misra S, Thatipelli MR, Howe PW, et al. (2008) Preliminary study of the use of drug-eluting stents in atherosclerotic renal artery stenoses 4 mm in diameter or smaller. J Vasc Interv Radiol 19(6):833–839

    Article  PubMed  Google Scholar 

  86. Tegtmeyer CJ, Elson J, Glass TA, et al. (1982) Percutaneous transluminal angioplasty: the treatment of choice for renovascular hypertension due to fibromuscular dysplasia. Radiology 143(3):631–637

    CAS  PubMed  Google Scholar 

  87. Tollefson DF, Ernst CB (1991) Natural history of atherosclerotic renal artery stenosis associated with aortic disease. J Vasc Surg 14(3):327–331

    Article  CAS  PubMed  Google Scholar 

  88. Slovut DP, Olin JW (2004) Fibromuscular dysplasia. N Engl J Med 350(18):1862–1871

    Article  CAS  PubMed  Google Scholar 

  89. Tegtmeyer CJ, Selby JB, Hartwell GD, Ayers C, Tegtmeyer V (1991) Results and complications of angioplasty in fibromuscular disease. Circulation 83(2 Suppl):I155–I161

    CAS  PubMed  Google Scholar 

  90. Sos TA, Pickering TG, Sniderman K, et al. (1983) Percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma or fibromuscular dysplasia. N Engl J Med 309(5):274–279

    Article  CAS  PubMed  Google Scholar 

  91. Thatipelli MR, Huettl E, McKusick M, Misra S (2009, in press) Angioplasty for renal artery fibromuscular dysplasia in older hypertensive patients. Angiology. doi:10.1177/0003319709335512

  92. Cooper CJ, Murphy TP, Matsumoto A, et al. (2006) Stent revascularization for the prevention of cardiovascular and renal events among patients with renal artery stenosis and systolic hypertension: rationale and design of the CORAL trial. Am Heart J 152(1):59–66

    Article  PubMed  Google Scholar 

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Thatipelli, M., Misra, S. Endovascular intervention for renal artery stenosis. Abdom Imaging 35, 612–621 (2010). https://doi.org/10.1007/s00261-009-9572-1

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