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Int J Cardiol 2020 May 20. Epub 2020 May 20.

Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.

Background: Pulmonary embolism (PE) is a frequent cause of death and morbidity. A few studies suggest that clot burden in pulmonary artery bed is related to PE patients' survival, but the impact of concomitant deep venous thrombosis and/or thrombophlebitis (DVT) on short-term survival of PE patients remains unclear. Thus, we aimed to investigate the impact of DVT on adverse outcomes in PE patients. Read More

J Matern Fetal Neonatal Med 2020 May 22:1-8. Epub 2020 May 22.

Atlanta Perinatal Associates, Atlanta, GA, USA.

Complication rates associated with peripherally inserted central catheters (PICCs) in the general population are variable, and rates specific to pregnant women are unclear. We conducted a systematic review and meta-analysis to estimate the rate of PICC-associated complications in pregnant women. We searched published literature for records discussing PICC use in pregnant or postpartum women. Read More

J Vasc Surg Venous Lymphat Disord 2020 Apr 27. Epub 2020 Apr 27.

Stony Brook Medicine, Stony Brook, New York. Electronic address:

Introduction: Initial Phase III clinical studies with polidocanol endovenous microfoam (PEM) have demonstrated safety and efficacy in the treatment of superficial venous reflux. In those studies, the primary outcome requirement was to assess improvement in symptoms related to superficial venous disease. The goal of this study was to evaluate the efficacy of PEM technology in routine clinical practice, specifically closure rates following treatment. Read More

Internist (Berl) 2020 Jun;61(6):617-620

Krankenhaus Bad Waldsee, Oberschwabenklinik gGmbH, Robert-Koch-Straße 38, 88339, Bad Waldsee, Deutschland.

The case of a 72-year-old female patient with exanthem and concomitant neuropathy of the instep of the foot and progressive ipsilateral lower leg pain is reported. Sonographically, a superficial vein thrombosis with extension into the deep venous system originating from the exanthem was observed. On the basis of the clinical picture as well as the serological and electrophysiological findings, a rare diagnosis of acrodermatitis chronica atrophicans with peripheral neuropathy was made, which could significantly promote the local development of venous thrombosis. Read More

J Vasc Surg Venous Lymphat Disord 2020 Mar 20. Epub 2020 Mar 20.

Department of Statistics, Purdue University, West Lafayette, Ind.

Background: Insurance approval for saphenous vein ablation is generally limited to junctional reflux involving the great saphenous vein (GSV) or small saphenous vein. This study was designed to investigate prevalence and disease severity of anterior accessory GSV (AAGSV) compared with GSV disease in patients presenting to dedicated outpatient vein centers.

Methods: Deidentified data were pulled from the American Vein & Lymphatic Society PRO Venous Registry for first and second patient encounters. Read More

Georgian Med News 2020 Jan(298):13-16

Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine.

Acute thrombophlebitis of the superficial veins is an urgent problem as it can spread to the deep veins with the subsequent development of pulmonary embolism. The social implications of varicotrombophlebitis are the long-term disability of most patients up to complete disability, so finding the least invasive methods of correction of the discussed disease is a pressing issue of modern phlebology. The research objective is to carry out a comparative analysis of the quality of life of patients with acute ascending thrombophlebitis of the great sapheneous vein after treatment with high-frequency endovenous welding and standard phlebectomy. Read More

Natl Med J India 2019 May-Jun;32(3):134-136

Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.

Background: Thromboangiitis obliterans (TAO) or Buerger disease is a recurring progressive segmental vasculopathy that presents with inflammation and thrombosis of small and medium arteries and veins of the hands and feet. The exact cause remains unknown, with tobacco use (primarily smoking but also smokeless tobacco) being highly associated with the disease. The diagnosis is clinical and the lack of a diagnostic gold standard is a deterrent to diagnosing it in patients with atypical presentations. Read More

Cureus 2020 Jan 15;12(1):e6665. Epub 2020 Jan 15.

Internal Medicine, Dow University of Health Sciences, Karachi, PAK.

Protein C (PC) and protein S (PS) are natural anticoagulants that protect the body against thrombosis, and their deficiency, either inherited or acquired, renders the body to a hypercoagulable state. This leads to venous thromboembolism manifesting as thrombosis, pulmonary embolism and superficial thrombophlebitis among other causes. The involvement of arteries is rare and has been explained by only a few studies. Read More

J Coll Physicians Surg Pak 2020 Feb;30(2):216-218

University of Health Sciences, Sultan Abdulhamid Han Research and Training Hospital, Department of Urology, Istanbul, Turkey.

Thrombosis or thrombophlebitis of the superficial dorsal vein of the penis is called penile Mondor's disease. Although many factors are suggested as the etiology, but it has not been clarified yet. Hypersensitivity reactions may predispose to this complication in some patients; and it results from the formation of antigen-antibody immune complexes in the circulation as a consequence of the penetration of antigenic debris into the circulation due to pruritus-related excoriations caused by parasitic infestations like scabies. Read More

Blood 2020 Apr;135(16):1377-1385

Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.

The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) is challenging, because persistent intravascular abnormalities after previous DVT often hinder a diagnosis by compression ultrasonography. Magnetic resonance direct thrombus imaging (MRDTI), a technique without intravenous contrast and with a 10-minute acquisition time, has been shown to accurately distinguish acute recurrent DVT from chronic thrombotic remains. We have evaluated the safety of MRDTI as the sole test for excluding recurrent ipsilateral DVT. Read More

Am J Case Rep 2020 Jan 14;21:e919715. Epub 2020 Jan 14.

Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.

BACKGROUND Multifocal superficial thrombophlebitis is a rare clinical manifestation with wide differential diagnosis in relation to the background disease. CASE REPORT Here we report on 2 patients who presented with a systemic inflammatory response, multifocal thrombophlebitis, and orbital inflammation in whom a diagnosis of a defined background disease could not be established. CONCLUSIONS The clinical pattern of our 2 cases might represent a distinctive, not yet defined systemic medical condition. Read More

J Vasc Surg Venous Lymphat Disord 2020 Jan 6. Epub 2020 Jan 6.

Department of Interventional Radiology, Fourth Affiliated Hospital, Jiangsu University, Jiangsu, China.

Objective: In foam sclerotherapy for varicose veins, ultrasound can track the spread of foam in only one direction. We hypothesized that using fluoroscopy in combination with ultrasound can reveal the spread of foam to deep veins through perforator veins and to other varicose veins in different directions. In this study, we examined the safety and effectiveness of ultrasound- and fluoroscopy-guided foam sclerotherapy for lower extremity venous ulcers. Read More

BMJ Case Rep 2019 Dec 15;12(12). Epub 2019 Dec 15.

Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.

Mondor's disease (MD) is a rare disease characterised by thrombophlebitis of superficial veins in the body. We describe a case of a 28-year-old woman with a painful cord-like lesion of the right breast (3 cm) overlying the right upper quadrant. The patient was recently prescribed metformin and oral contraceptive pills for symptomatic polycystic ovarian syndrome. Read More

J Vasc Bras 2019 Nov 20;18:e20180105. Epub 2019 Nov 20.

Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

Superficial venous thrombosis (SVT) or superficial thrombophlebitis is characterized by thrombi within superficial veins, with partial involvement or occlusion of the lumen and inflammatory reaction along the course of the vein. Clinical diagnosis tends to be straightforward, but supplementary tests and examinations are needed to confirm thrombosis extension and possible thromboembolic complications. SVT can be associated with deep venous thrombosis in 6 to 40% of cases, with asymptomatic pulmonary embolism (PE) in 20 to 33%, and with symptomatic PE in 2 to 13%. Read More

Clin Case Rep 2019 Nov 7;7(11):2283-2284. Epub 2019 Oct 7.

Department of Radiology Chris Hani Baragwanath Academic Hospital University of the Witwatersrand Soweto South Africa.

Penile Mondor's disease or thrombophlebitis of the superficial dorsal penile vein is a rare disorder of the penis. Reported cases in the literature are mostly focal thrombus. We present clinical and sonographic images of an extensive superficial dorsal penile vein thrombosis. Read More

Oxf Med Case Reports 2019 Aug 28;2019(8):omz075. Epub 2019 Aug 28.

Section of Hematology, Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.

We here present a case of a 59-year-old man with Mondor's disease, thrombophlebitis of the superficial veins of the anterior chest wall. This occurred after the patient had initiated extensive training with walking poles, Nordic walking, probably predisposing to the thrombosis. Underlying disease was ruled out, and the treatment was symptomatic. Read More

Khirurgiia (Mosk) 2019 (10):50-54

Medical Innovative Phlebology Center, Moscow, Russia.

Objective: To study the results of endovenous laser obliteration (EVLO) for acute thrombophlebitis of saphenous veins of the lower extremities.

Material And Methods: There were 57 patients (39 (68%) men and 18 (32%) women), mean age of patients was 54±20 years (range 34-74) with acute ascending thrombophlebitis of varicose superficial veins of the lower extremities (type I and II). EVLO of great saphenous vein was performed in 48 cases, small saphenous vein - in 9 patients. Read More

J Vasc Surg Venous Lymphat Disord 2019 11 5;7(6):860-864. Epub 2019 Sep 5.

Department of Surgery, Division of Vascular and Endovascular Surgery, UCLA Medical Center, Los Angeles, Calif.

Objective: Lower extremity venous aneurysms may lead to serious morbidity in patients, including pulmonary embolism (PE) and chronic venous insufficiency. Presently, because of the low incidence of these aneurysms, no consensus for their treatment exists. The purpose of this study was to review the presentation and management of lower extremity venous aneurysms at our institution. Read More

Knee Surg Sports Traumatol Arthrosc 2020 Feb 29;28(2):439-447. Epub 2019 Jul 29.

Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.

Purpose: To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30-day post-operative complications.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30-day post-operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses. Read More

Phlebology 2020 May 27;35(4):281-287. Epub 2019 Jul 27.

Division of Vascular Surgery - Villa del Sole, Salerno, Italy.

Case Rep Emerg Med 2019 23;2019:5984251. Epub 2019 May 23.

Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan.

The patient was a 64-year-old woman with systemic lupus erythematosus, thrombophlebitis of the lower legs, cerebral infarction with left hemiparesis, and colostomy after perforation of the sigmoid colon. On the morning of her presentation, the patient felt epigastric abnormality. Thereafter, hematemesis occurred twice, leading her to call an ambulance in the afternoon. Read More

Br J Community Nurs 2019 06;24(6):263-264

Lecturer, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Anesth Essays Res 2019 Jan-Mar;13(1):155-157

Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

Background And Aims: The association of superficial thrombophlebitis (ST) with deep-venous thrombosis varies between 6% and 44%. Thus, prevention of ST is important. The aim of this study was to compare the efficacy of topical quick penetrating solution (QPS) of heparin 1000 IU/mL versus diclofenac QPS for prevention of postinfusion ST. Read More

J Vet Diagn Invest 2019 Jul 25;31(4):554-556. Epub 2019 Apr 25.

Federal University of Minas Gerais School of Veterinary Medicine, Belo Horizonte, Minas Gerais, Brazil (Gonzaga, Lages, Carvalho, Filho, Meneses, Pierezan).

Cases of cranial superficial epigastric vein (CSEV) phlebitis with subsequent septicemia were observed in dairy farms in Minas Gerais, Brazil. Autopsy on 4 affected cows, from 2 farms, revealed CSEV thrombophlebitis with perivascular abscesses, pulmonary abscesses, valvular endocarditis, arthritis, thromboembolic nephritis, and renal infarcts. Microscopic examination revealed fibrosing and lymphoplasmacytic phlebitis with occasional endothelial loss, subendothelial areas of necrosis, and abundant fibrin deposition. Read More

Clin Appl Thromb Hemost 2019 Jan-Dec;25:1076029619839150

2 Oakland University William Beaumont School of Medicine, Rochester, MI, USA.

Catheter-related (CR) thrombosis is a significant complication of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Limited existing data for MCs suggest a favorable complication profile for MCs. To compare incidence of CR thrombosis between MCs and PICCs and to evaluate the impact of quantity of lumens and catheter diameter on CR thrombosis. Read More

Arch Med Sci 2019 Mar 4;15(2):393-401. Epub 2019 Mar 4.

Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia.

Introduction: Little is known about pathogenetic mechanisms of superficial venous thrombosis (SVT). We aimed to investigate the systemic inflammatory response in the acute phase of SVT, the time course of inflammatory markers and involvement of inflammation in resolution of thrombus in SVT.

Material And Methods: The circulatory inflammatory parameters high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor α (TNF-α), interleukins 6, 8 and 10 (IL-6, IL-8, IL-10), and markers of fibrinolytic activity tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined in 68 patients with acute SVT of lower limbs, who were allocated to two groups, dalteparin 5000 IU once daily or 10 000 IU once daily. Read More

Z Rheumatol 2019 May;78(4):365-371

Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.

Hughes-Stovin syndrome (HSS), characterized by the combination of multiple pulmonary artery aneurysms and deep vein thrombosis, is a rare and an under-recognized clinical entity with less than 40 published cases in English medical literature. Vascular venous thrombotic events, as occurring in the course of Behçet's disease (BD), are also described in HSS, e. g. Read More

PLoS One 2019 13;14(3):e0213754. Epub 2019 Mar 13.

University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, The Netherlands.

Common methods to detect phlebitis may not be sufficient for patients in the intensive care unit (ICU). The goal of this study was to investigate the feasibility of infrared (IR) thermography to objectively detect phlebitis in adult ICU patients. We included a total of 128 adult ICU-patients in a pilot and subsequent validation study. Read More

Aesthetic Plast Surg 2019 08 19;43(4):927-929. Epub 2019 Feb 19.

Adella Aesthetic, 15G, Tintyava Str., 1172, Sofia, Bulgaria.

Mondor's disease is the eponym used to describe a self-limited phlebitis or thrombophlebitis of the superficial veins localized mainly on the thoracoabdominal area of the human body. Its clinical manifestation includes painful superficial cords causing skin retraction. This medical condition could be idiopathic, iatrogenic or a manifestation of underlying pathology such as breast cancer and seems to be more common than has been previously thought. Read More

Indian J Pharmacol 2018 Nov-Dec;50(6):344-349

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: Thrombosis and thrombophlebitis of the superficial venous system are common in hospitalized patients. Efficacy and safety of topical quick penetrating solution (QPS) of heparin were compared to heparin sodium topical gel for the prevention of infusion-associated phlebitis.

Materials And Methods: Patients aged 18-65 years undergoing intravenous cannulation for at least 72 h were enrolled and randomized to receive 6-8 drops of topical solution of heparin (Group sodium topical solution [QPS]) or1 g of topical gel (Group GEL) over the cannulated vein every 8 hourly for a total of 10 doses. Read More

Blood 2019 02 14;133(9):906-918. Epub 2019 Jan 14.

Heart Research Institute, Newtown, NSW, Australia.

Thrombosis with associated inflammation (thromboinflammation) occurs commonly in a broad range of human disorders. It is well recognized clinically in the context of superficial thrombophlebitis (thrombosis and inflammation of superficial veins); however, it is more dangerous when it develops in the microvasculature of injured tissues and organs. Microvascular thrombosis with associated inflammation is well recognized in the context of sepsis and ischemia-reperfusion injury; however, it also occurs in organ transplant rejection, major trauma, severe burns, the antiphospholipid syndrome, preeclampsia, sickle cell disease, and biomaterial-induced thromboinflammation. Read More

Blood Coagul Fibrinolysis 2019 Mar;30(2):80-84

Laboratorio de Hematología, Sanatorio Allende.

: Hypodysfibrinogenemia and protein C deficiency are coagulopathies and in this report, we describe a young patient with both defects confirmed by molecular genetic tests. The patient was a 24-year-old woman referred for recurrent thrombophlebitis and finally deep venous thrombosis. Routine coagulation studies revealed mild decrease of protein C (0. Read More

Cochrane Database Syst Rev 2018 Dec 31;12:CD004328. Epub 2018 Dec 31.

Royal National Throat, Nose and Ear Hospital, 330 Gray's Inn Road, London, UK, WC1X 8DA.

Background: Epistaxis (nosebleed) most commonly affects children and the elderly. The majority of episodes are managed at home with simple measures. In more severe cases medical intervention is required to either cauterise the bleeding vessel, or to pack the nose with various materials. Read More

J Cutan Aesthet Surg 2018 Jul-Sep;11(3):132-135

Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany.

Background: Mondor's disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor's disease remains unclear. Usually, it is a self-limited disease. Read More

Acta Chir Belg 2019 Apr 2;119(2):137-138. Epub 2018 Nov 2.

a Department of Vascular Surgery , KAT General Hospital , Athens , Greece.

This is a rare case of a young patient with Klippel-Trenaunay syndrome that presented with extensive septic superficial thrombophlebitis of the lower extremity. Treatment included intravenous antibiotics based on cultures, anticoagulant therapy as well as surgical removal of thrombi. Read More

JAMA 2018 12;320(22):2367-2368

Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands.

Clinical Question: Which treatments for lower extremity superficial thrombophlebitis (ST) are associated with lower rates of venous thromboembolic events (VTEs) vs placebo?

Bottom Line: A dose of 2.5 mg of fondaparinux administered subcutaneously once daily for 45 days is associated with fewer cases of symptomatic VTE without an increase in major bleeding vs placebo. Low-molecular-weight heparin (LMWH) and nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with lower rates of ST extension or recurrence vs placebo, but data regarding symptomatic VTE remain inconclusive. Read More

Open Forum Infect Dis 2018 Oct 1;5(10):ofy249. Epub 2018 Oct 1.

Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Background: Catheter-related septic thrombosis is suspected in patients with persistent central line-associated bloodstream infection (CLABSI) after 72 hours of appropriate antimicrobial therapy. The clinical diagnosis and management of this entity can be challenging as limited data are available. We retrospectively studied the clinical characteristics of patients with catheter-related septic thrombosis and the outcomes related to different management strategies. Read More

J Pharm Sci 2018 11 25;107(11):2883-2890. Epub 2018 Jul 25.

Center for Drug Delivery Research, Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta, Georgia, 30341. Electronic address:

Heparinoid is commonly used for the treatment of superficial thrombophlebitis, a condition wherein inflammation and clotting occurs in the veins below the skin surface. However, stratum corneum is a major barrier that limits the delivery of hydrophilic heparinoid, in and across the skin. The aim of the present study was to develop a nonirritant topical formulation for heparinoid incorporating chemical penetration enhancers and investigate the delivery of heparinoid across the human epidermis using in vitro vertical Franz diffusion cells. Read More

Vasc Endovascular Surg 2018 Nov 18;52(8):633-635. Epub 2018 Jun 18.

1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA.

Background:: We report the case of a 90-year old woman who presented with septic pulmonary emboli due to suppurative thrombophlebitis at an old peripheral intravenous site.

Methods:: After unsuccessful treatment with antibiotics, the patient was taken to the operating room for excision and drainage of the purulent superficial vein.

Results:: We review the literature and discuss the presentation, risk factors, treatment options, and complications of this often-overlooked disease entity. Read More

Case Rep Emerg Med 2018 12;2018:4205628. Epub 2018 Apr 12.

Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36065 Santa Fe Avenue, Fort Hood, TX 76544, USA.

Dorsal Vein thrombosis, also known as Mondor's disease of the penis, is a superficial thrombophlebitis first described in the literature by Falco in 1955. Mondor's disease refers to a superficial thrombophlebitis of any locale. Diagnosis can be made clinically with palpation of a mobile, cord-like thickening on dorsum of penis without associated evidence of inflammation, infection, or dermatologic changes. Read More

Evid Based Complement Alternat Med 2018 24;2018:2983195. Epub 2018 Apr 24.

Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine and Research Unit for Complementary and Integrative Laser Medicine, TCM Research Center Graz, Medical University of Graz, 8036 Graz, Austria.

Acute superficial thrombophlebitis is a venous system disease. Animal models with mannitol induced phlebitis were treated with an orally administered "phlebitis ointment." 24 rabbits were randomly divided into 4 groups. Read More

Intern Med 2018 Sep 18;57(18):2607-2612. Epub 2018 May 18.

Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Japan.

Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. Cases of MD can be roughly categorized into three different groups based on the site of the lesion as follows: original MD of the anterolateral thoracoabdominal wall, penile MD with dorsum and dorsolateral aspects of the penis, and axillary web syndrome with mid-upper arm after axillary surgery. Read More

J Pediatr 2018 09 26;200:289. Epub 2018 Apr 26.

Division of Clinical Immunology and Allergy Children's Hospital Los Angeles Department of Pediatrics Keck School of Medicine University of Southern California Los Angeles, California.

Minerva Med 2018 Aug 24;109(4):276-279. Epub 2018 Apr 24.

Gemelli Policlinic, Rome, Italy -

Background: Superficial thrombophlebitis (STP) is a relatively frequent pathology characterized by possible extension to the deep venous circulation, with notable local inflammatory reaction which is treated by subcutaneous administration of Fondaparinux. Stasis dermo-hypodermitis is characterized by cutaneous hyperpigmentation and eczema, treatment for which consists of the use of drugs targeting endothelial cells (mesoglycan, FFPM, sulodexide). In this study we evaluated the impact of local application of a mixture of semi-synthetic polysulfated galactosaminoglycans on the regression rate of STP and dermo-hypodermitis in patients treated with best medical therapy (BMT). Read More

Ann Vasc Dis 2018 Mar;11(1):52-56

Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan.

Vascular Behçet's disease (BD) would keep risk of anastomotic pseudoaneurysm due to deterioration of the disease even after vascular surgery was successfully done. Therefore, it is one of the least-welcome diseases for vascular surgeons. There still exist several points on a concept and criteria of the vascular BD which not only general practitioners but also the vascular surgeons do not understand. Read More