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Li Y, Mükke A, Rother U, Janka R, Uder M, Lang W, Heiss R. Effect of Flat-Knitted Medical Compression Stockings on Venous Malformations. J Clin Med 2023; 12:jcm12072723. [PMID: 37048806 PMCID: PMC10094853 DOI: 10.3390/jcm12072723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
Abstract
Venous malformations are one of the most common vascular anomalies. Our study aimed to investigate the effect of medical compression stockings of class I and II on the volume of venous malformations. Patients with venous malformations on upper or lower extremities were enrolled. They wore flat-knitted medical compression stockings of class I and II in a randomized order for four weeks each. Magnetic resonance imaging (MRI) and perometry were performed with and without wearing compression stockings. The 12-Item Short Form Survey (SF-12) questionnaire was performed before and after wearing compression stockings for four weeks each. A total of 18 patients completed the evaluations. Both compression classes showed a significant reduction of the volume of the venous malformations in the lesion itself based on MRI in comparison with baseline (both p < 0.001). Measurements taken with perometry did not reveal a significant difference in comparison to baseline (p = 0.09 and p = 0.22). The results of the SF-12 questionnaire demonstrated no significant differences before and after wearing the compression stockings of class I or class II for four weeks or between the two classes of compression therapy. Our results indicate that wearing medical compression stockings of both class I and class II significantly reduces the volume of venous malformation, without compromising the quality of life, while the effect of class II compression stockings on volume reduction was significantly better than that of class I.
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Affiliation(s)
- Yi Li
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Antje Mükke
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Rolf Janka
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, D-91054 Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, D-91054 Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, D-91054 Erlangen, Germany
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Imaging features and enhancement technique to diagnose and classify intrathoracic Lymphatic-venous malformations: A case report and literature review. Radiol Case Rep 2021; 16:1888-1894. [PMID: 34113413 PMCID: PMC8170020 DOI: 10.1016/j.radcr.2021.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022] Open
Abstract
The diagnosis and treatment of pediatric intrathoracic lymphatic-venous malformations (LVM) can be complex due to their rarity, variable presentation and confusing nomenclature in the literature. The International Society for the Study of Vascular Anomalies (ISSVA) has recently (2018) updated their classification to help guide the correct diagnosis, nomenclature and management of such cases. We present the case of a 12-month-old Caucasian female with a lymph-venous malformation (LVM) classified in the updated ISSVA classification as a combined vascular malformation (CLVM) defined as two or more vascular malformations found in one lesion, associated with an underlying “malformation of an individual named vessel”. The patient presented with tachypnea, tachycardia and fever. While all the previous cases underwent surgical treatment, our patient was successfully treated with rapamycin and sclerotherapy. Appropriate imaging can aid in the diagnosis of vascular anomalies and in the proper ISSVA classification, saving the patient the need for a biopsy and allow for proper referral to Multidisciplinary Vascular Anomalies centers. The accurate classification can identify cases that can be treated through Interventional Radiology with sclerosing agents and medical therapy as opposed to surgery.
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PAOLACCI S, MATTASSI RE, CAVALCA D, MICHELINI S, ZULIAN A, CRISTOFOLI F, MANARA E, MARCEDDU G, BERTELLI M. Genetic testing in vascular and lymphatic malformations. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.23736/s1824-4777.21.01487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ohta T, Matsubara S. Nosological Consideration of Arterial Aneurysms Associated with Klippel-Trenaunay Syndrome. Ann Vasc Dis 2020; 13:359-364. [PMID: 33391551 PMCID: PMC7758587 DOI: 10.3400/avd.ra.20-00089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Klippel–Trenaunay syndrome (KTS) is a rare slow-flow combined vascular malformation characterized by capillary-lymphatic-venous lesions with soft tissue overgrowth of the limbs. We report the case of a 37-year-old female KTS patient with a deep femoral arterial aneurysm. We finally diagnosed that the aneurysm had resulted from a fundamental defect in the arterial wall structure. We discuss whether the use of “aneurysm associated with KTS” is accurate and how to better classify this type of capillary-venous lesion in 17 reported KTS patients with arterial aneurysms. In this review, we describe nosological problems of arterial aneurysms associated with KTS.
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Affiliation(s)
- Takashi Ohta
- Department of Vascular Surgery, Daiyukai Daiichi Hospital, Ichinomiya, Aichi, Japan
| | - Shinobu Matsubara
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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Commentary on Effectiveness and Safety of Ethanol for the Treatment of Venous Malformations. Dermatol Surg 2020; 46:1519-1520. [PMID: 33252460 DOI: 10.1097/dss.0000000000002387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paolacci S, Mattassi RE, Marceddu G, Manara E, Zulian A, Guerri G, De Antoni L, Arduino C, Cavalca D, Bertelli M. Somatic Variant Analysis Identifies Targets for Tailored Therapies in Patients with Vascular Malformations. J Clin Med 2020; 9:jcm9113387. [PMID: 33105631 PMCID: PMC7690376 DOI: 10.3390/jcm9113387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022] Open
Abstract
Vascular malformations include various disorders characterized by morphological, structural and/or functional alterations of blood and lymph vessels. Most are sporadic, due to somatic mutations. Here, we report a cohort of patients with sporadic and/or unifocal vascular malformations, in whom we carried out next generation sequencing analysis of a panel of genes associated with vascular malformations. The 115 patients analyzed were from different clinical centres. In 37 patients (32%), we found pathogenic mutations: most of these were gain-of-function mutations in PIK3CA (18%, 21/115) and TEK (13/115, 11%). We also found mutations in GNAQ, CCM2 and PTEN. Identifying pathogenic variants in patients with vascular malformations can help improve management, particularly in cases with activating mutations that cause an increase in cell proliferation. Personalized pharmacological treatment, if possible, is now considered preferable to surgery and can help prevent recurrences, i.e., long-term complications of residual malformation or regrowth of tumors. For instance, rapamycin is currently being investigated for the treatment of various vascular malformations associated with hyperactivation of the phosphoinositide 3-kinase/Akt/mammalian target of rapamycin (PI3K/Akt/mTOR) pathway.
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Affiliation(s)
- Stefano Paolacci
- MAGI’S LAB, Via delle Maioliche, 57/D, 38068 Rovereto, TN, Italy; (A.Z.); (G.G.); (M.B.)
- Correspondence: ; Tel.: +39-046-442-0795
| | - Raul Ettore Mattassi
- Center for Vascular Malformations “Stefan Belov”, Clinical Institute Humanitas “Mater Domini”, Via Gerenzano, 2, 21053 Castellanza, VA, Italy;
| | - Giuseppe Marceddu
- MAGI EUREGIO, Via Maso della Pieve, 60/A, 39100 Bolzano, Italy; (G.M.); (E.M.); (L.D.A.)
| | - Elena Manara
- MAGI EUREGIO, Via Maso della Pieve, 60/A, 39100 Bolzano, Italy; (G.M.); (E.M.); (L.D.A.)
| | - Alessandra Zulian
- MAGI’S LAB, Via delle Maioliche, 57/D, 38068 Rovereto, TN, Italy; (A.Z.); (G.G.); (M.B.)
| | - Giulia Guerri
- MAGI’S LAB, Via delle Maioliche, 57/D, 38068 Rovereto, TN, Italy; (A.Z.); (G.G.); (M.B.)
| | - Luca De Antoni
- MAGI EUREGIO, Via Maso della Pieve, 60/A, 39100 Bolzano, Italy; (G.M.); (E.M.); (L.D.A.)
| | - Carlo Arduino
- Medical Genetics Unit, City of Health and Science, Corso Bramante, 88, 10126 Turin, Italy;
| | - Daniela Cavalca
- Laser Surgery Operating Unit, Plastic Surgery Department, San Rocco Clinical Institute, Via dei Sabbioni, 24, 25050 Ome, BS, Italy;
| | - Matteo Bertelli
- MAGI’S LAB, Via delle Maioliche, 57/D, 38068 Rovereto, TN, Italy; (A.Z.); (G.G.); (M.B.)
- MAGI EUREGIO, Via Maso della Pieve, 60/A, 39100 Bolzano, Italy; (G.M.); (E.M.); (L.D.A.)
- EBTNA–LAB, Via delle Maioliche, 57/G, 38068 Rovereto, TN, Italy
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Banzic I, Brankovic M, Maksimović Ž, Davidović L, Marković M, Rančić Z. Parkes Weber syndrome-Diagnostic and management paradigms: A systematic review. Phlebology 2016; 32:371-383. [PMID: 27511883 DOI: 10.1177/0268355516664212] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives Parkes Weber syndrome is a congenital vascular malformation which consists of capillary malformation, venous malformation, lymphatic malformation, and arteriovenous malformation. Although Parkes Weber syndrome is a clinically distinctive entity with serious complications, it is still frequently misdiagnosed as Klippel-Trenaunay syndrome that consists of the triad capillary malformation, venous malformation, and lymphatic malformation. Methods We performed a systematic review investigating clinical, diagnostic, and treatment modalities of Parkes Weber syndrome (PubMed/MEDLINE, Embase, and Cochrane databases). Thirty-six publications (48 patients) fulfilled the eligibility criteria. Results The median age of patients was 23 years (IQR, 8-32), and 24 (50.0%) were males. Lower extremity was affected in 42 (87.5%) and upper extremity in 6 (12.5%) patients; 15 (31.3%) patients developed high-output heart failure; 12 (25.0%) patients had chronic venous ulcerations, whereas 4 (8.3%) manifested distal arterial ischemia. The spinal arteriovenous malformations were reported in six (12.5%) patients and coexistence of aneurysmatic disease in five (10.4%) patients. The most frequently utilized invasive treatments were embotherapy followed by amputation and surgical arteriovenous malformation resection, and occasionally stent-graft implantation. All modalities showed clinical improvement. However, long follow-up and outcome remained unclear. Conclusion A diagnosis of Parkes Weber syndrome should be made on the presence of capillary malformation, venous malformation, lymphatic malformation, and arteriovenous malformation (as main defect) in overgrowth extremity. Arteriovenous malformation presents the criterion for distinguishing Parkes Weber syndrome from Klippel-Trenaunay syndrome, which is substantial for treatment strategy. The primary management goal should be patient's quality of life improvement and complication reduction. Embolization alone/combined with surgical resection targeting occlusion or removal of arteriovenous malformation "nidus" reliably leads to clinical improvement.
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Affiliation(s)
- Igor Banzic
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,2 Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milos Brankovic
- 3 Department of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands
| | - Živan Maksimović
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,2 Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Lazar Davidović
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,2 Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Miroslav Marković
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,2 Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Zoran Rančić
- 4 Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Commentary on Neodymium-Doped Yttrium Aluminium Garnet Laser Treatment of Pediatric Venous Malformation in the Oral Cavity. Dermatol Surg 2016; 42:880-2. [PMID: 27191779 DOI: 10.1097/dss.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Malgor RD, Gloviczki P, Fahrni J, Kalra M, Duncan AA, Oderich GS, Vrtiska T, Driscoll D. Surgical treatment of varicose veins and venous malformations in Klippel–Trenaunay syndrome. Phlebology 2015; 31:209-15. [DOI: 10.1177/0268355515577322] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Klippel–Trenaunay syndrome (KTS) is a mixed mesenchymal malformation characterised by varicose veins, venous and capillary malformations, and hypertrophy of soft tissue and bone. The purpose of this study was to evaluate the surgical outcomes in KTS patients to provide standards for comparison with endovenous therapy. Methods The clinical data of consecutive patient with KTS who underwent open venous surgical treatment between January 1987 and December 2008 were reviewed. Demographics, clinical presentation, operative data, and clinical outcomes were recorded. Follow-up information was obtained from the medical records, mailed questionnaires and phone calls. Descriptive statistics, the Kaplan–Meier method and Log-rank statistics were used where appropriate. Results Twenty-seven females and 22 males, (mean age 26.5 years, range 7.7–55.8) were included in this study. All had varicose veins, 36 (73%) had limb hypertrophy, and 33 (67%) had capillary malformations, with two of three clinical features present in all. The most frequent symptom was pain (N = 43, 88%). Forty-nine patients underwent operations on 53 limbs. Stripping of the GSV, small and accessory saphenous and lateral embryonic veins was performed in 17 (32%), 10 (19%), 9 (17%), and 15 (28%) limbs, respectively. Two patients developed deep vein thrombosis, one had pulmonary embolism (PE), and one patient had peroneal nerve palsy. Freedom from disabling pain at 1, 3 and 5 years was 95%, 77% and 59%, respectively, and freedom from secondary procedures was 78% at 3 years, and 74% at 5 years. At the last follow-up visit, the venous clinical severity score had decreased from 9.48 ± 3.27 to 6.07 ± 3.20 (P < 0.001). Conclusions In selected symptomatic patients with KT syndrome, open surgical treatment is safe and durable. Three-fourths of the patients remain free of disabling pain at five years, but secondary procedures are required in one-fourth of the patients. These data can serve as standards for comparison of endovenous therapy for KT syndrome.
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Affiliation(s)
- Rafael D Malgor
- Division of Vascular and Endovascular Surgery, The University of Oklahoma College of Medicine, Tulsa, Oklahoma, USA
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Fahrni
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Audra A Duncan
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Terri Vrtiska
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David Driscoll
- Vascular Malformation Clinic, Gonda Vascular Center, Mayo Clinic, Rochester, USA
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10
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Markovic JN, Shortell CEK. Multidisciplinary treatment of extremity arteriovenous malformations. J Vasc Surg Venous Lymphat Disord 2014; 3:209-18. [PMID: 26993843 DOI: 10.1016/j.jvsv.2014.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
Congenital vascular malformations (CVMs) are a complex group of lesions that arise by embryologic dysmorphogenesis without increased endothelial proliferation that leads to structural and functional anomalies of the vascular system characterized by a wide range of presenting symptoms and often unpredictable clinical course. A recent advancement in the diagnostic and treatment modalities has resulted in a better understanding of the pathophysiology and natural history of CVMs and improved management of these lesions. The multidisciplinary approach and diagnostic algorithm used to distinguish high-flow (HFVM) from low-flow vascular malformations (LFVM) have been validated as clinically applicable for making an accurate anatomic and hemodynamic diagnosis of CVMs; they serve as a basis for proper treatment selection and significantly facilitate communication among different medical specialists. Dynamic contrast-enhanced magnetic resonance imaging is able to definitively distinguish HFVM from LFVM with accuracy of approximately 84%. In inconclusive cases, confirmatory angiography is required. Symptomatic, diffuse, extensive, macrocystic LFVMs and LFVMs that involve multiple tissue planes and vital structures are best treated with foam sclerotherapy. Primary surgical resection is the treatment of choice for localized, septated, and microcystic LFVMs. The management of HFVMs is characterized by multimodal treatment including preoperative embolization followed by complete surgical resection or sclerotherapy of the remaining venous component. Treatment of extensive CVMs is palliative and goal oriented. Implementation of the proposed diagnostic protocols and therapeutic algorithms in a multidisciplinary setting results in favorable outcomes with acceptable complication rates in this challenging patient population.
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Affiliation(s)
- Jovan N Markovic
- Department of Vascular Surgery, Duke University Medical Center, Durham, NC.
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Fahrni JO, Cho EYN, Engelberger RP, Baumgartner I, von Känel R. Quality of life in patients with congenital vascular malformations. J Vasc Surg Venous Lymphat Disord 2013; 2:46-51. [PMID: 26992968 DOI: 10.1016/j.jvsv.2013.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 08/29/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess quality of life (QoL) in patients with congenital vascular malformations (CVMs) and to identify factors of CVMs associated with poor QoL, including high psychological and/or somatic (physical) distress. METHODS We evaluated 71 patients (mean age, 40 ± 16 years; 51% women) with arteriovenous (n = 10), venous/capillary (n = 34), lymphatic (n = 10), and combined (n = 17) malformations. All patients completed validated psychometric assessment tools, which were the 36-Item Short Form Health Survey, the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire-15, and the Pain Disability Index. RESULTS Compared with population norms, the group of CVM patients as a whole showed lower 36-Item Short Form Health Survey Physical (46 vs 50) and Mental (46 vs 52) Component Summary scores, indicating impaired physical and mental health. In addition, 13% of patients with CVMs had clinically relevant psychological distress (Hospital Anxiety and Depression Scale total scores ≥17), and 15% had increased somatic distress (Patient Health Questionnaire-15 total scores ≥10). Greater levels of psychological and somatic distress were significantly associated with lower scores of virtually all of the eight 36-Item Short Form Health Survey subscales (P < .05). CONCLUSIONS Our findings suggest that, compared with a normal population, CVM patients have a lower QoL that is accompanied by increased psychological and somatic distress. In treating patients with CVMs, it is important to be aware of the psychological impact of this rare illness and to offer appropriate support.
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Affiliation(s)
- Jennifer O Fahrni
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - En-Young N Cho
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Bern University Hospital, Inselspital, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Rolf P Engelberger
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Iris Baumgartner
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Roland von Känel
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Bern University Hospital, Inselspital, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland.
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