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Hammer S, da Silva NPB, Müller J, Fellner C, Greiner B, Ingrid Huf V, Stroszczynski C, Wohlgemuth WA, Uller W. Structured magnetic resonance imaging-based characterization of the marginal vein reveals limits of the Weber-classification. VASA 2023. [PMID: 37082826 DOI: 10.1024/0301-1526/a001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Background: The marginal vein (MV) is a persisting embryonic vein located at the lateral aspect of the lower limb. The Weber-classification, which was developed on the basis of phlebography in the 1990s, is the only existing classification system for this rare disease. Aim of this study was the structured characterization of the lateral marginal vein (MV) using magnetic resonance imaging (MRI) and evaluation of the applicability of the Weber-classification. Patients and methods: Institutional Review Board approval was obtained for this retrospective, single-center study. All patients who underwent contrast-enhanced MRI (using a prospectively determined protocol) of the untreated MV were included. MV anatomy and associated findings were characterized in a structured way taking into account the criteria of the Weber-classification for MV: inflow, outflow and extension. If three criteria of the Weber-classification were fulfilled the MV was categorized as "classifiable according to Weber". The MV was categorized as "partially classifiable according to Weber", if two criteria were met and as "not classifiable according to Weber" if less than two criteria were applicable. Results: 56 imaging studies of 58 MV (7 thoracoabdominal, 51 lower extremities) were reviewed. 18/51 MV of the lower extremities were "classifiable" according to the Weber-classification. 33/51 lower extremity MV were not definitely categorized according to the Weber-classification: 19/51 MV were "partially classifiable" and 14/51 MV were "not classifiable". 30/51 MV presented with hypoplastic, 1/51 with aplastic deep venous system. 34/51 lower extremity and 6/7 thoracoabdominal MV were associated with an additional vascular malformation (VM). Conclusions: MRI is suitable for detailed anatomic characterization of the MV and reveals additional therapy relevant findings like associated VM. The Weber-classification was not applicable in most cases, reflecting its limits and the heterogeneity of this rare disease. Structured reports rather than an obsolete classification system should be preferred for MRI of the MV.
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Affiliation(s)
- Simone Hammer
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Natascha Platz Batista da Silva
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Johanna Müller
- Department of Internal Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Veronika Ingrid Huf
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Walter Alexander Wohlgemuth
- Department of Radiology, Medical Center University of Halle (Saale), Faculty of Medicine, University of Halle (Saale), Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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2
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Liebetrau D, Marnoto R, Goßlau Y, Zerwes S, Stangl F, Wohlgemuth WA, Hyhlik-Dürr A. Die Marginalvene – nach wie vor eine seltene Entität: Fallserie von 16 Patienten. DIE CHIRURGIE 2022; 93:892-898. [PMID: 35767078 PMCID: PMC9399208 DOI: 10.1007/s00104-022-01648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/07/2022]
Abstract
Hintergrund Die Marginalvene (MV) ist eine angeborene, vorwiegend venöse Gefäßmalformation, die auf einer fehlenden Rückbildung des embryonalen Venensystems an den unteren Extremitäten beruht. Sie geht mit einer Vielzahl an Komplikationen einher. Bisher werden in der Literatur keine einheitlichen Therapieregime beschrieben. Fragestellung Welche Behandlungsstrategien und Ergebnisse gibt es bei Patienten mit MV? Material und Methoden Im Zeitraum 01.01.2008 bis 31.12.2020 wurden alle am Universitätsklinikum Augsburg behandelten Patienten mit Marginalvene retrospektiv aufgearbeitet. Ergebnisse Das mediane Alter zum Diagnosezeitpunkt lag bei 14,8 Jahren (3–42 Jahre). 12/16 Patienten hatten eine Beinlängendifferenz. 75 % der Patienten (12/16) hatten bereits zur Diagnosestellung MV eine chronisch-venöse Insuffizienz (CVI). Im untersuchten Kollektiv wurden 62,5 % (10/16) der Patienten zum Zeitpunkt der Diagnosestellung mittels Kompression konservativ behandelt. Bei weiteren 31,3 % (5/16) der Patienten erfolgte primär eine offen-chirurgische Entfernung der MV und bei 1/16 Patienten wurde die MV primär mittels endovenöser Lasertherapie (EVLT) verschlossen; 15/16 Patienten wurden sekundär therapiert. 2,6 ± 2,4 (MW ± SD) Sekundärprozeduren wurden pro Patient im Follow up durchgeführt. Das mittlere Follow-up lag bei 8,1 Jahren. Diskussion Zur Prävention/Vermeidung einer Progression einer CVI und Thrombembolieprophylaxe sollte nach Diagnosestellung die MV zeitnah verschlossen/entfernt werden. Die Anwendung chirurgisch-konventioneller Techniken zur Entfernung der MV scheint gegenüber der Behandlung mit minimal-invasiven Prozeduren hinsichtlich der Anzahl der erforderlichen Sekundäreingriffe von Vorteil.
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3
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Schmidt VF, Olivieri M, Häberle B, Masthoff M, Deniz S, Sporns PB, Wohlgemuth WA, Wildgruber M. Interventional Treatment Options in Children with Extracranial Vascular Malformations. Hamostaseologie 2022; 42:131-141. [PMID: 35263769 DOI: 10.1055/a-1728-5686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Martin Olivieri
- Paediatric Thrombosis and Haemostasis Unit, Dr. von Hauner Children's Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Max Masthoff
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Sinan Deniz
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
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4
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Jones KM, Corey KC, Garza-Mayers AC, Spencer SA, Mulliken JB, Chewning RH, Liang MG. Classification of lower extremity venous malformations and risk of knee involvement: A retrospective cohort study. J Am Acad Dermatol 2021; 85:1480-1485. [PMID: 33421482 DOI: 10.1016/j.jaad.2020.12.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Venous malformation (VM) is the most common vascular anomaly in the lower extremity. VMs can be classified as focal, multifocal, or diffuse types. Intraarticular VM (IA-VM) of the knee portends morbidity. Association of the lower extremity VM type with IA-VM is not well defined. OBJECTIVE To classify a large cohort of lower extremity, nonsyndromic VMs by type and determine associations with IA-VM. METHODS Retrospective cohort study. RESULTS We assessed 156 patients with nonsyndromic, lower extremity VM; 71 (46%) were focal and 85 (54%) were diffuse type VM, and 97 (62%) were IA-VM. Of diffuse VMs, 26 (31%) were Bockenheimer and 59 (69%) were localized subtypes. Pure VM had a significantly elevated risk of IA-VM (relative risk [RR], 2.34; 95% confidence interval [CI], 1.42-3.89). IA-VM was more common in diffuse (73%) versus focal (49%) types. Risk of IA-VM in diffuse type VM was significantly elevated (RR, 1.48; 95% CI, 1.13-1.94). One hundred percent of diffuse Bockenheimer type VM had IA-VM, and this subtype had the highest risk (RR, 1.83; 95% CI, 1.56-2.14) of IA-VM. LIMITATIONS Retrospective, single-institution study. CONCLUSIONS Intraarticular involvement of the knee should be considered in all lower extremity VMs. Pure VM and the Bockenheimer diffuse VM subtype had the highest risk of IA-VM.
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Affiliation(s)
- Krystal M Jones
- Dermatology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristen C Corey
- Dermatology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John B Mulliken
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rush H Chewning
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marilyn G Liang
- Dermatology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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5
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Cyrek AE. Eine außergewöhnliche Therapie der Vena-iliaca-externa-Hypoplasie bei einer Patientin mit Klippel-Trénaunay-Syndrom – ein Fallbericht. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1134-8807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ZusammenfassungDas Klippel-Trénaunay-Syndrom (KTS) ist eine seltene und komplexe Fehlbildung. Sie zeigt die typische Trias aus vaskulärer Malformation, Knochen- und Weichteilhypertrophie sowie venöser Varikosis. Die Systemmanifestationen werden in einem individuell variablen Muster beobachtet. Eine isolierte angeborene Hypoplasie des venösen Systems tritt jedoch in den seltensten Fällen auf. Aus diesem Grund spielt die Früherkennung eine wichtige Rolle für die weitere Behandlungsplanung. So können durch rechtzeitige Behandlung schwere Krankheitsverläufe oder Spätfolgen vermieden werden. Eine isolierte angeborene Hypoplasie ist extrem selten und prädisponiert insbesondere im jungen Erwachsenenalter für Becken- oder Beinvenenthrombosen. Bei dieser Krankheit wird selten eine chirurgische Rekonstruktion durchgeführt.Wir beschreiben einen sehr seltenen Fall einer 60-jährigen Frau mit KTS, die vor 28 Jahren einen venösen Crossover-Bypass (Palma) mittels Vena saphena magna bei Hypoplasie der Vena iliaca externa rechts erhalten hat. Das Ziel des vorliegenden Berichts ist das klinische Erscheinungsbild, den diagnostischen Prozess und das Krankheitsmanagement vorzustellen sowie eine Literaturübersicht zum operativen Behandlungsverfahren darzustellen.
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Affiliation(s)
- Anna Ewa Cyrek
- Sektion Gefäßchirurgie und Endovaskuläre Chirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen
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6
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Lim Y, Fereydooni A, Brahmandam A, Dardik A, Choate K, Nassiri N. Mechanochemical and surgical ablation of an anomalous upper extremity marginal vein in CLOVES syndrome identifies PIK3CA as the culprit gene mutation. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:438-442. [PMID: 32775850 PMCID: PMC7396827 DOI: 10.1016/j.jvscit.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/15/2020] [Indexed: 01/17/2023]
Abstract
Anomalous marginal veins of the trunk or extremities are congenitally incompetent entities found in association with phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-related overgrowth syndromes, such as Klippel-Trénaunay syndrome and congenital lipomatous overgrowth, vascular malformations, epidermal nevi, and skeletal deformities (CLOVES) syndrome. When present, they can be a major source of venous hypertension-related morbidity and potentially lethal thromboembolic events. Herein, we describe a rare case of an upper extremity marginal vein in a patient with CLOVES syndrome. Through a multimodal therapeutic approach, we identified a somatic PIK3CA mutation in the excised anomalous vein. This finding questions the validity of commonly employed terminology, such as persistent embryonic vein, in reference to these anomalous entities.
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Affiliation(s)
- Young Lim
- Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, Conn.,Department of Dermatology, Yale University School of Medicine, New Haven, Conn
| | - Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Anand Brahmandam
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Keith Choate
- Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, Conn.,Department of Dermatology, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Vascular Malformations Program (VaMP), Yale New Haven Hospital, New Haven, Conn.,Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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7
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Kota AA, Agarwal S. Significance of lateral marginal vein in Klippel-Trenaunay syndrome. ANZ J Surg 2020; 91:E61-E62. [PMID: 32574397 DOI: 10.1111/ans.16113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/02/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Sunil Agarwal
- Department of Vascular Surgery, Christian Medical College, Vellore, India
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8
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Fereydooni A, Nassiri N. Evaluation and management of the lateral marginal vein in Klippel-Trénaunay and other PIK3CA-related overgrowth syndromes. J Vasc Surg Venous Lymphat Disord 2020; 8:482-493. [PMID: 32089498 DOI: 10.1016/j.jvsv.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/16/2019] [Indexed: 01/19/2023]
Abstract
The lateral marginal vein is an anomalous clinical entity found in association with Klippel-Trénaunay and other PIK3CA-related overgrowth syndromes. Although it is reported to affect <20% of patients with Klippel-Trénaunay syndrome, this venous anomaly has been associated with significant morbidity and mortality attributable to venous hypertension and potentially lethal thromboembolic events. Limited literature exists on the diagnosis and management of this rare anomaly, with most of the reports focusing on retrospective clinical experience at a few centers of excellence. Despite these limitations, a systematic approach to diagnosis and treatment of this anomaly is warranted and expounded on herein. When plausible, clinical recommendations based on best available literature are made.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
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9
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Bittles M, Jodeh DS, Mayer JLR, Gallant M, Rottgers SA. Laser ablation of embryonic veins in children. Pediatr Int 2019; 61:358-363. [PMID: 30742735 DOI: 10.1111/ped.13804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/29/2018] [Accepted: 02/07/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Trenaunay syndrome (KTS) and related overgrowth syndromes are rare conditions that often present to academic pediatric units and multidisciplinary vascular anomaly clinics. These conditions are commonly associated with abnormalities of the superficial and deep venous structures and carry an increased risk of venous thromboembolism. METHODS A retrospective chart review was completed of all patients treated at Johns Hopkins All Children's Hospital with endovenous laser ablation therapy (EVLT) for management of dilated embryonic veins in the setting of limb overgrowth. RESULTS Three patients with limb overgrowth underwent EVLT between 2015 and 2017. All patients had successful occlusion of the targeted veins on post-procedure imaging. One patient developed a cellulitis successfully treated with oral antibiotics. CONCLUSIONS Endovenous laser ablation therapy is a well-tolerated and safe procedure for prophylactic closure of abnormal superficial embryonic veins. This study supports the use of this technique in managing increased thromboembolic risk in this unique patient population and recognizes the need for a long-term study to determine its efficacy.
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Affiliation(s)
- Mark Bittles
- Department of Radiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jennifer L R Mayer
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Michael Gallant
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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10
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Radiofrequency Ablation of the Marginal Venous System in Patients with Venous Malformations. Cardiovasc Intervent Radiol 2018; 42:213-219. [DOI: 10.1007/s00270-018-2099-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
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11
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Transcatheter embolization of persistent embryonic veins in venous malformation syndromes. J Vasc Surg Venous Lymphat Disord 2017; 5:749-755. [DOI: 10.1016/j.jvsv.2017.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/01/2017] [Indexed: 01/19/2023]
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12
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Lee BB, Laredo J, Kim YW, Neville R. Congenital Vascular Malformations: General Treatment Principles. Phlebology 2017; 22:258-63. [DOI: 10.1177/026835550702200606] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The era where surgical excision alone was the sole treatment of venous malformation (VM) is now over. A multidisciplinary approach that utilizes both traditional surgical therapy and endovascular therapy is now the standard of care. Endovascular therapy utilizing primarily both embolization therapy and sclerotherapy is the treatment of choice for surgically ‘inaccessible' VM lesions. Surgical therapy of VM lesions has been shown to be more effective when combined with supplemental endovascular therapy.
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Affiliation(s)
- B B Lee
- Department of Surgery, Georgetown University, Washington, DC, USA
| | - J Laredo
- Department of Surgery, Georgetown University, Washington, DC, USA
| | - Y W Kim
- Department of Surgery, SungKyunKwan University
- SamSung Medical Centre, Seoul, Korea
| | - R Neville
- Department of Surgery, Georgetown University, Washington, DC, USA
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13
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Abstract
The marginal vein, an abnormal superficial vein of the lateral lower limb, is a remnant of primitive embryonic vessels that have failed to regress. According to the extent, topography and sites of connection with the deep veins, five types have been distinguished by Weber. The marginal vein is valveless and may create venous stasis. Limb–length discrepancy and nevus may coexist. Diagnosis is made by duplex scan examination and phlebography; angio computerized tomography or magnetic resonance effectively demonstrates the vein but yield less haemodynamic data. The best treatment is complete surgical resection of the vein. Resection should be avoided in the rare cases when aplasia of the deep veins exists. A careful skeletonization can be performed if arterio-venous fistulas converge into the vein.
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Affiliation(s)
- R Mattassi
- Department of Vascular Surgery, Centre for Vascular Malformations ‘Stefan Belov’, ‘G Salvini’ Hospital, Garbagnate Milanese, Milano, Italy
| | - M Vaghi
- Department of Vascular Surgery, Centre for Vascular Malformations ‘Stefan Belov’, ‘G Salvini’ Hospital, Garbagnate Milanese, Milano, Italy
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14
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Baba A, Yamazoe S, Okuyama Y, Shimizu K, Kobashi Y, Nozawa Y, Munetomo Y, Mogami T. A rare presentation of Klippel-Trenaunay syndrome with bilateral lower limbs. J Surg Case Rep 2017; 2017:rjx024. [PMID: 28458832 PMCID: PMC5400491 DOI: 10.1093/jscr/rjx024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/17/2017] [Accepted: 01/27/2017] [Indexed: 01/19/2023] Open
Abstract
Klippel–Trenaunay syndrome (KTS) is a vascular lymphatic malformation underlying with bony and soft tissue hypertrophy. It is a rare condition presenting in 1 out of 10 000 people. The growth disturbance due to KTS is more commonly unilateral (85%) than bilateral (12.5%), and most rarely crossed-bilateral (2.5%). A man in his 40s presented to our hospital with a complaint of lower limb discomfort. Radiograph, ultrasonography, computed tomography venography, magnetic resonance (and venography) showed various radiological findings characteristic for KTS. Because the patient was symptomatic, he underwent stripping of bilateral great saphenous vein and varicectomy of bilateral legs. The surgical procedures were undertaken successfully, and there has been no recurrent symptom for about 2 years and a half. In this study, we report a very rare case of bilateral KTS diagnosed by radiological and clinical manifestations with some literature review.
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Affiliation(s)
- Akira Baba
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Shinji Yamazoe
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Yumi Okuyama
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Kanichiro Shimizu
- Department of Radiology, The Jikei University Kashiwa Hospital,Kashiwa, Chiba, Japan
| | - Yuko Kobashi
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Yosuke Nozawa
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Yohei Munetomo
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Takuji Mogami
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
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15
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Hu L, Chen H, Yang X, Liu M, Yan M, Lin X. Joint dysfunction associated with venous malformations of the limbs: Which patients are at high risk? Phlebology 2017; 33:89-96. [PMID: 28741421 DOI: 10.1177/0268355517693101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives Joint dysfunction occurs frequently in patients with venous malformations of the extremities. This study aims to describe the risk factors of joint dysfunction in these patients. Method We retrospectively collected clinical and radiological aspects of 168 patients with extremity venous malformations from January 2013 to August 2015. Patients were categorized into "with joint dysfunction" or "without joint dysfunction" groups according to the symptoms. Results Forty-four (26%) patients were assigned into with joint dysfunction group. Univariate analysis showed that the significant variables were age (P = 0.008), location (P = 0.005), size (P < 0.001), involved tissue (P < 0.001), visual analogue scale scores of pain (P = 0.004), pain duration (P = 0.018), and therapy history (P < 0.001). Multivariate analysis showed that the factors associated with joint dysfunction were age below 10 years (adjusted odds ratio = 2.70, P = 0.004), lower limb (adjusted odds ratio = 2.72, P = 0.042), pain duration over 1 year (adjusted odds ratio = 3.47, P = 0.001) and therapy history (yes) (adjusted odds ratio = 3.71, P = 0.004). Conclusion This study provides preliminary evidence indicating which patients are at high risk for joint dysfunction associated with limb venous malformations.
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Affiliation(s)
- Li Hu
- 1 Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, China
| | - Hui Chen
- 1 Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, China
| | - Xi Yang
- 1 Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, China
| | - Ming Liu
- 2 Department of Orthopedics, Shanghai Jiao Tong University School of Medicine, China
| | - Mengning Yan
- 2 Department of Orthopedics, Shanghai Jiao Tong University School of Medicine, China
| | - Xiaoxi Lin
- 1 Department of Plastic and Reconstructive Surgery, Shanghai Jiao Tong University School of Medicine, China
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16
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Volz KR, Kanner CD, Evans J, Evans KD. Klippel-Trénaunay Syndrome: Need for Careful Clinical Classification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2057-2065. [PMID: 27492391 DOI: 10.7863/ultra.15.08007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/20/2015] [Indexed: 06/06/2023]
Abstract
Klippel-Trénaunay syndrome (KTS) is a rare congenital malformation characterized by a triad of clinical presentations: (1) capillary malformations manifesting as a "port wine stain"; (2) limb hypertrophy; and (3) venous varicosities. It is distinguished from Parkes-Weber syndrome by the absence of substantial arteriovenous shunting. Due to the clinical implications of an arteriovenous fistula, differentiation between the two syndromes is important, as the prognosis and treatment greatly differ. We present a series of 5 cases of suspected KTS, while emphasizing the difficulties in distinguishing KTS from Parkes-Weber syndrome without diagnostic imaging and underscoring the importance of accurately classifying patients with the appropriate syndrome.
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Affiliation(s)
- Kevin R Volz
- School of Health and Rehabilitation Sciences, The Ohio State University, College of Medicine, Columbus, Ohio USA
| | - Christopher D Kanner
- School of Health and Rehabilitation Sciences, The Ohio State University, College of Medicine, Columbus, Ohio USA
| | - Julie Evans
- Division of Vascular Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio USA
| | - Kevin D Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, College of Medicine, Columbus, Ohio USA
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Qiao JB, Li J, Zhang XF. Analysis and Treatment of Multiple Severe Venous Vascular Malformation Syndrome Combined with Coagulopathy. Chin Med J (Engl) 2015; 128:2546-8. [PMID: 26365978 PMCID: PMC4725554 DOI: 10.4103/0366-6999.164987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Xie-Fu Zhang
- Department of General Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
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Oduber CEU, Young-Afat DA, van der Wal AC, van Steensel MAM, Hennekam RCM, van der Horst CMAM. The persistent embryonic vein in Klippel–Trenaunay syndrome. Vasc Med 2013; 18:185-91. [DOI: 10.1177/1358863x13498463] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Klippel–Trenaunay syndrome (KTS) is a congenital malformation syndrome with prominent vascular anomalies. A persistent embryonic vein (PEV) may be located on the affected leg(s) of patients with KTS. Our understanding of PEVs of the legs is limited and their nomenclature is confusing. The objective of this study was to obtain further insight in the prevalence, nomenclature and etiology of PEVs of the legs in KTS and to propose a standardized description of anomalous leg veins in KTS. We investigated 70 KTS patients for the presence of PEVs (lateral marginal vein, LMV) of the legs by duplex ultrasonography. We performed histopathological analysis of a surgically excised PEV (LMV) of a typical KTS patient, and we conducted an extensive literature study. Duplex ultrasonography showed LMVs in 12/70 (17.1%) patients. The terms used to describe PEVs in the leg are quite variable, while indicating only two types: lateral marginal vein (LMV) and persistent sciatic vein (PSV). The histology of the excised LMV showed remarkable similarity with that of varicose veins found in the general population. In conclusion, the prevalence of LMVs in our KTS cohort is 17.1%. Two PEVs can be found in the legs and we propose nomenclature based on anatomical criteria, thereby using only the terms persistent lateral marginal vein and persistent sciatic vein, combined with the patency of the deep venous system. We hypothesize that PEVs are most likely caused by a genetic defect leading to abnormal venous pattern formation, which is further supported by our histopathological findings.
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Affiliation(s)
- Charlène EU Oduber
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Maurice AM van Steensel
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Raoul CM Hennekam
- Department of Paediatrics, Academic Medical Center, Amsterdam, The Netherlands
- Clinical and Molecular Genetics Unit, Institute of Child Health, Great Ormond Street Hospital for Children, UCL, London, UK
| | - Chantal MAM van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Lee BB. Venous malformation and haemangioma: differential diagnosis, diagnosis, natural history and consequences. Phlebology 2013; 28 Suppl 1:176-87. [DOI: 10.1177/0268355513475960] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Venous malformation (VM) is the most common form of congenital vascular malformation (CVM). VM presents at birth as an inborn vascular defect and never disappears/regresses spontaneously through the rest of life; it will continue to grow slowly at a rate that is proportional to the growth rate of the body. Haemangioma is not a vascular malformation but one of the vascular tumours originating from the endothelial cells; it develops after birth mostly in the infantile/neonatal period with a distinctive growth cycle: a proliferation phase of early rapid growth followed by an involutional phase of slow regression. Although the vascular malformation and vascular tumour belong to the ‘vascular anomaly’ together, both conditions are fundamentally different not only in their anatomical, histological and pathophysiological findings but also in their clinical courses. Therefore, an appropriate differential diagnosis of the VM is mandated not only from other kinds of CVMs but also from ‘genuine’ haemangioma. Appropriate diagnosis and assessment of VMs can be made based on clinical presentation and a proper combination of basic non-invasive studies in general but the presence of a mixed lesion involving other types of CVM lesions and the type of VM lesion, extratruncular and truncular, will dictate the need for further work-up with additional non- to less-invasive study or angiography. Otherwise, angiography is usually reserved for therapeutic planning and treatment.
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Affiliation(s)
- B B Lee
- Center for the Lymphedema and Vascular Malformations, George Washington University, Washington, DC, USA
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Yamaki T, Konoeda H, Fujisawa D, Ogino K, Osada A, Hamahata A, Nozaki M, Sakurai H. Prevalence of various congenital vascular malformations in patients with Klippel-Trenaunay syndrome. J Vasc Surg Venous Lymphat Disord 2012; 1:187-93. [PMID: 26992342 DOI: 10.1016/j.jvsv.2012.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/18/2012] [Accepted: 07/25/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Klippel-Trenaunay syndrome (KTS) is a condition defined by the association of three physical features: capillary malformation, varicosities, and hypertrophy of bony and soft tissues. However, KTS is characterized by congenital vascular malformations (CVMs) that are difficult to classify. Therefore, the present study was undertaken to analyze the various CVMs in patients with KTS. METHODS Sixty-one patients with KTS were enrolled, and their CVMs were divided into predominantly venous defects, predominantly lymphatic defects, and mixed vascular defects using the Hamburg Classification. Capillary malformations were subdivided into port-wine stain, telangiectasia, and angiokeratoma. Truncular and extratruncular vascular malformations were detected using duplex ultrasound and magnetic resonance imaging. Reflux in the superficial and deep venous systems was also evaluated. RESULTS Forty-five patients (74%) had predominantly venous defects, four (6%) had predominantly lymphatic defects, and 12 (20%) had mixed vascular defects. Capillary malformations were detected in 54 patients (89%), among which port-wine stain was the most predominant (40 patients, 66%), followed by telangiectasia (31 patients, 51%) and angiokeratoma (18 patients, 30%). Extratruncular venous malformations were detected in 47 patients (77%). In contrast, truncular venous malformations were found in 50 patients (82%). Among these, embryonic lateral marginal vein showed the highest occurrence, accounting for 53% (32 patients). However, reflux in this vein was detected in only nine patients (15%). Twelve patients (20%) had reflux in the great saphenous vein, and four (7%) had reflux in the small saphenous vein. Deep vein hypoplasia was found in seven patients (12%), and only five patients (8%) had deep vein aplasia. Extratruncular lymphatic malformations were found in 13 patients (21%) and truncular lymphatic malformations in 17 (28%). CONCLUSIONS Patients with KTS have a variety of CVMs, but both extratruncular and truncular venous malformations continue to be targets for intervention.
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Affiliation(s)
- Takashi Yamaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hisato Konoeda
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kota Ogino
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuyoshi Osada
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsumori Hamahata
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Motohiro Nozaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Roh YN, Do YS, Park KB, Park HS, Kim YW, Lee BB, Pyon JK, Lim SY, Mun GH, Kim DI. The Results of Surgical Treatment for Patients With Venous Malformations. Ann Vasc Surg 2012; 26:665-73. [DOI: 10.1016/j.avsg.2011.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/15/2011] [Accepted: 12/06/2011] [Indexed: 11/30/2022]
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Alomari AI. Diversion venography--a modified technique in Klippel-Trenaunay syndrome: initial experience. J Vasc Interv Radiol 2010; 21:685-9. [PMID: 20227297 DOI: 10.1016/j.jvir.2010.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 09/06/2009] [Accepted: 01/19/2010] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate an initial experience with diversion venography, a modified venographic technique, to assess the deep venous system in patients with Klippel-Trenaunay syndrome (KTS). MATERIALS AND METHODS Eight patients with KTS underwent diversion venography of the affected lower extremities. The technique of diversion venography included the use of multiple methods to divert blood flow into the deep venous system, such as application of multiple tourniquets, cannulation of the tibial and popliteal veins, multiple imaging projections, and temporary endoluminal occlusion of the lateral venous system. All studies were done under general anesthesia before surgical or interventional procedures. RESULTS The technique of diversion venography was successful in opacifying the deep venous system in all eight patients studied. No complications were encountered. CONCLUSIONS Diversion venography successfully visualizes the deep venous system in patients with KTS. This can potentially expand the treatment options for these patients.
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Affiliation(s)
- Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Children's Hospital Boston, Boston, MA 02115, USA.
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Zea MI, Hanif M, Habib M, Ansari A. Klippel-Trenaunay Syndrome: a case report with brief review of literature. J Dermatol Case Rep 2009; 3:56-9. [PMID: 21886734 DOI: 10.3315/jdcr.2009.1038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/20/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Tranuanay Syndrome is a rare sporadic disease characterized by clinical triad of capillary malformation; soft tissue and bony hypertrophy; and atypical varicosity. Although this syndrome was first described more than hundred years ago, exact incidence has not been estimated yet. Several theories have been postulated to describe its pathogenesis. Clinical presentation of this syndrome is protean ranging from minimal asymptomatic disease to life threatening bleeding and embolism. Management of this syndrome includes careful diagnosis, prevention and treatment of complications. MAIN OBSERVATION We are presenting a case of Klippel-Tranuanay Syndrome in a 19-year-old male patient presenting with varicosity in lateral aspect of right leg. On careful examination other components of the syndrome were found. Patient was kept on yearly follow up. CONCLUSION Usually patients with Klippel-Tranuanay Syndrome present with complication. This case shows that there is also a need for medical solutions in patients who seek advise for cosmetic reasons.
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Affiliation(s)
- Mohammad Iqbal Zea
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh, U P, 202002, India
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