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Strategies to Treat Venous Reflux Disease

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Abstract

An estimated 30% of adults in the United States have some degree of venous reflux disease. These may range from subclinical reflux to aesthetic asymptomatic varicosities noted in the superficial tissue to advanced chronic venous disease (CVD) with ulcerations and pain. Given the variety of presentations of patients with venous reflux disease, CVD can be classified using the revised CEAP classification system and/or by using the revised Venous Clinical Severity Score (VCSS). Various treatment modalities are available, including nonoperative and operative management. This chapter focuses on the various modalities available for use and the risks and benefits of each modality and discusses some controversial topics in venous reflux disease. At a minimum, clinical follow-up should include CEAP classification and VCSS scores.

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References

  1. Rabe E, Pannier F. Epidemiology of chronic venous disorders. In: Gloviczki P, editor. Handbook of venous disorders: guidelines of the American Venous Forum. 3rd ed. London: Hodder Arnold; 2009. p. 105–10.

    Google Scholar 

  2. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, et al. The epidemiology of venous thromboembolism in the community. Thromb Hemost. 2001;86:452–63.

    CAS  Google Scholar 

  3. Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. Quality of life in patients with chronic venous disease: San Diego population study. J Vasc Surg. 2003;37(5):1047–53.

    Article  PubMed  Google Scholar 

  4. Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh vein study. J Epidemiol Community Health. 1999;53(3):149–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Robertson LA, Evans CJ, Lee AJ, Allan PL, Ruckley CV, Fowkes FG. Incidence and risk factors for venous reflux in the general population: Edinburgh vein study. Eur J Vasc Endovasc Surg. 2014;48(2):208–14.

    Article  CAS  PubMed  Google Scholar 

  6. Laurikka JO, Sisto T, Tarkka MR, Auvinen O, Hakama M. Risk indicators for varicose veins in forty- to sixty-year-olds in the Tampere varicose vein study. World J Surg. 2002;26:648–51.

    Article  PubMed  Google Scholar 

  7. Onida S, Davies AH. CHIVA, ASVAL and related techniques—concepts and evidence. Phlebology. 2015;30(2 Suppl):42–5.

    Article  PubMed  Google Scholar 

  8. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S.

    Article  PubMed  Google Scholar 

  9. Almeida JI. Atlas of endovascular venous surgery. Philadelphia: Saunders/Elsevier; 2012.

    Google Scholar 

  10. Norton JA, Bollinger RR, Chang AE, Lowry SF. Surgery: basic science and clinical evidence, vol. 3. New York: Springer; 2001. p. 980–1.

    Book  Google Scholar 

  11. Friedman SG. A history of vascular surgery. Mount Kisco, NY: Futura Pub.; 1989.

    Google Scholar 

  12. Labropoulos N, Giannoukas AD, Delis K, Mansour MA, Kang SS, Nicolaides AN, et al. Where does venous reflux start? J Vasc Surg. 1997;26:736–42.

    Article  CAS  PubMed  Google Scholar 

  13. Todd KL, Wright DI, The VANISH-2 Investigator Group. The VANISH-2 study: a randomized, blinded, multicenter study to evaluate the efficacy and safety of polidocanol endovenous microfoam 0.5% and 1.0% compared with placebo for the treatment of saphenofemoral junction incompetence. Phlebology. 2014;29(9):608–18.

    Article  PubMed  Google Scholar 

  14. Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs—UIP consensus document. Part II. Anatomy. Eur J Vasc Endovasc Surg. 2006;31:288–99.

    Article  CAS  PubMed  Google Scholar 

  15. McMullin GM, Smith C. An evaluation of Doppler ultrasound and photoplethysmography in the investigation of venous insufficiency. Aust N Z J Surg. 1992;62:270–5.

    Article  CAS  PubMed  Google Scholar 

  16. Blebea J, Kihara TK, Neumyer MM, Blebea JS, Anderson KM, Atnip RG. A national survey of practice patterns in the noninvasive diagnosis of deep venous thrombosis. J Vasc Surg. 1999;29:799–804.

    Article  CAS  PubMed  Google Scholar 

  17. Markel A, Meissner MH, Manzo RA, Bergelin RO, Strandness DE Jr. A comparison of the cuff deflation method with Valsalva’s maneuver and limb compression in detecting venous valvular reflux. Arch Surg. 1994;129:701–5.

    Article  CAS  PubMed  Google Scholar 

  18. van Bemmelen PS, Bedford G, Beach K, Strandness DE. Quantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning. J Vasc Surg. 1989;10:425–31.

    Article  PubMed  Google Scholar 

  19. Nicolaides AN, Cardiovascular Disease Educational and Research Trust, European Society of Vascular Surgery, the International Angiology Scientific Activity Congress Organization, International Union of Angiology, Union Internationale de Phlebologie at the Abbaye des Vaux de Cernay. Investigation of chronic venous insufficiency: a consensus statement (France, March 5–9, 1997). Circulation. 2000;129:E126–63.

    Article  Google Scholar 

  20. Abai B, Labropoulos N. Duplex ultrasound scanning for chronic venous obstruction and valvular incompetence. In: Gloviczki P, editor. Handbook of venous disorders: guidelines of the American Venous Forum. 3rd ed. London: Hodder Arnold; 2009. p. 142–55.

    Google Scholar 

  21. Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A, et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs: UIP consensus document: part I. Basic principles. Eur J Vasc Endovasc Surg. 2006;31:83–92.

    Article  CAS  PubMed  Google Scholar 

  22. Struckmann JR. Assessment of the venous muscle pump function by ambulatory strain gauge plethysmography. Methodological and clinical aspects. Dan Med Bull. 1993;40:460–77.

    CAS  PubMed  Google Scholar 

  23. Criado E, Farber MA, Marston WA, Daniel PF, Burnham CB, Keagy BA. The role of air plethysmography in the diagnosis of chronic venous insufficiency. J Vasc Surg. 1998;27:660–70.

    Article  CAS  PubMed  Google Scholar 

  24. Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40:1248–52.

    Article  PubMed  Google Scholar 

  25. Vasquez MA, Rabe E, McLaffertyt RB, Shortell CK, Marston WA, Gillespie D, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010;52:1387–96.

    Article  PubMed  Google Scholar 

  26. Almeida JI, Wakefield T, Kabnick LS, Onyeachom U, Lal BK. Use of CEAP and VCSS to establish a treatment plan for chronic venous disorders. J Vasc Surg: Venous Lymphatic Disord. 2015;3:456–60.

    Google Scholar 

  27. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2005;111(18):2398–409.

    Article  PubMed  Google Scholar 

  28. Michaels JA, Campbell WB, Brazier JE, Macintyre JB, Palfreyman SJ, Ratcliffe J, et al. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess. 2006;10:1–196.

    Article  CAS  PubMed  Google Scholar 

  29. Franks PJ, Moffatt CJ, Connolly M, Bosanquet N, Oldroyd MI, Greenhalgh RM, et al. Factors associated with healing leg ulceration with high compression. Age Ageing. 1995;24:407–10.

    Article  CAS  PubMed  Google Scholar 

  30. Perälä J, Rautio T, Biancari F, Ohtonen P, Wiik H, Heikkinen T, et al. Radiofrequency endovenous obliteration versus stripping of the long saphenous vein in the management of primary varicose veins: 3-year outcome of a randomized study. Ann Vasc Surg. 2005;19:669–72.

    Article  PubMed  Google Scholar 

  31. Martinez-Zapata M, Vernooij RWM, Uriona Tuma SM, Stein AT, Moreno RM, Vargas E, et al. Phlebotonics for venous insufficiency. Cochrane Database Syst Rev. 2016;4:CD003229.

    PubMed  Google Scholar 

  32. Pavlovic MD. Drug treatment of chronic venous disease. Wien Med Wochenschr. 2016;166(9–10):312–9.

    Article  PubMed  Google Scholar 

  33. Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2006;25:CD003230.

    Google Scholar 

  34. Nelson EA, Prescott RJ, Harper DR, Gibson B, Brown D, Ruckley CV. A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers. J Vasc Surg. 2007;45:134–41.

    Article  PubMed  Google Scholar 

  35. Menyhei G, Gyevnar Z, Arato E, Kelemen O, Kollar L. Conventional stripping versus cryostripping: a prospective randomised trial to compare improvement in quality of life and complications. Eur J Vasc Endovasc Surg. 2008;35:218–23.

    Article  CAS  PubMed  Google Scholar 

  36. Holme JB, Skajaa K, Holme K. Incidence of lesions of the saphenous nerve after partial or complete stripping of the long saphenous vein. Acta Chir Scand. 1990;156:145–8.

    CAS  PubMed  Google Scholar 

  37. Yoh T, Okamura R, Nakamura Y, Kobayashi A. Divided saphenectomy for varicose vein in ambulatory surgery. Ann Vasc Dis. 2014;7(2):195–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Pittaluga P, Chastanet S, Locret T, Barbe R. The effect of isolated phlebectomy on reflux and diameter of the great saphenous vein: a prospective study. Eur J Vasc Endovasc Surg. 2010;40:122–8.

    Article  CAS  PubMed  Google Scholar 

  39. Franceschi C. Théorie et pratique de la cure conservatrice et hémodynamique de l’insuffisance veineuse en ambulatiore. Précy-sous-Thil: Editions de l’Armançon; 1988. (French)

    Google Scholar 

  40. Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2013;7:CD009648.

    Google Scholar 

  41. Boné C. Tratamiento endoluminal de las varices con laser de diodo: estudio preliminary. Rev Patol Vasc. 1999;5:35–46. (Spanish)

    Google Scholar 

  42. Kabnick LS. Outcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg. 2006;43:88–93.

    Article  PubMed  Google Scholar 

  43. Almeida J, Kaufman J, Göckeritz O, Chopra P, Evans MT, Hohein DF, et al. Radiofrequency endovenous closureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 2009;20(6):752–9.

    Article  PubMed  Google Scholar 

  44. Rasmussen L, Lawaetz M, Serup J, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J Vasc Surg: Venous Lymphatic Disord. 2013;1:349–56.

    Google Scholar 

  45. Brittenden J, Cotton SC, Elders A, Ramsay CR, Norrie J, Burr J, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014;371(13):1218–27.

    Article  CAS  PubMed  Google Scholar 

  46. van den Bos RR, Malskat WS, De Maeseneer MG, de Roos KP, Groeneweg DA, Kockaert MA, et al. Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous varicose veins. Br J Surg. 2014;101(9):1077–83.

    Article  PubMed  Google Scholar 

  47. Thomis S, Verbrugghe P, Milleret R, Verbeken E, Fourneau I, Herijgers P. Steam ablation versus radiofrequency and laser ablation: an in vivo histological comparative trial. Eur J Vasc Endovasc Surg. 2013;46(3):378–82.

    Article  CAS  PubMed  Google Scholar 

  48. Atasoy MM, Oğuzkurt L. The endovenous ASVAL method: principles and preliminary results. Diagn Interv Radiol. 2016;22(1):59–64.

    Article  PubMed  Google Scholar 

  49. Goldman M. Sclerotherapy treatment of varicose and telangiectatic leg vein, hardcover text. 2nd ed. Mosby: St. Louis; 1995.

    Google Scholar 

  50. Sharmi S, Cheatle T. Fegan’s compression sclerotherapy of varicose veins, hardcover text. Springer-Verlag: London; 2003.

    Book  Google Scholar 

  51. Hobbs JT. Surgery or sclerotherapy for varicose veins: 10-year results of a random trial. In: Tesi M, Dormandy JA, editors. Superficial and deep venous diseases of the lower limbs. Turin, Italy: Panminerva Medica; 1984. p. 243–8.

    Google Scholar 

  52. Cabrera J, Cabrera Garcia-Olmedo JR. Nuevo metodo de esclerosis en las varicas tronculares. Patol Vasc. 1995;4:55.

    Google Scholar 

  53. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27:58–60.

    CAS  PubMed  Google Scholar 

  54. Breu FX, Guggenbichler S, Wollmann JC. 2nd European consensus meeting on foam sclerotherapy 2006.Tegernsee, Germany. Vasa. 2008;37(Suppl 71):1–29.

    PubMed  Google Scholar 

  55. King JT, O’Byrne M, Vasquez M, Wright D, VANISH 1 Investigator Group. Treatment of truncal incompetence and varicose veins with a single administration of a new polidocanol endovenous microfoam preparation improves symptoms and appearance (VANISH-1). Eur J Vasc Endovasc Surg. 2015;50(6):784–93.

    Article  CAS  PubMed  Google Scholar 

  56. Elias S, Raines JK. Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial. Phlebology. 2012;27:67–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Morrison M, Gibson K, McEnroe S, Goldman M, King T, Weiss R, et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015;61(4):985–94.

    Article  PubMed  Google Scholar 

  58. Almeida JI, Javier JJ, Mackay E, Bautista C, Proebstle TM. First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphatic Disord. 2013;1:174–80.

    Article  Google Scholar 

  59. Proebstle TM, Alm J, Dimitri S, Rasmussen L, Whiteley M, Lawson J, Cher D, Davies A. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg: Venous Lymphatic Disord. 2015;3:2–7.

    Google Scholar 

  60. Fischer R, Linde N, Duff C, Jeanneret C, Chandler JG, Seeber P. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg. 2001;34(2):236–40.

    Article  CAS  PubMed  Google Scholar 

  61. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg. 2002;35:1190–6.

    Article  PubMed  Google Scholar 

  62. Raju S, Ward M, Jones TL. Quantifying saphenous reflux. J Vasc Surg: Venous Lymphatic Disord. 2015;3:8–17.

    Google Scholar 

  63. Lane TR, Kelleher D, Shepherd AC, Franklin IJ, Davies AH. Ambulatory varicosity avulsion later or synchronized (AVULS): a randomized clinical trial. Ann Surg. 2015;261(4):654–61.

    Article  PubMed  Google Scholar 

  64. Carradice D, Mekako AI, Hatfield J, Chetter IC. Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Int Angiol. 2008;27(Suppl 1):8–9.

    Google Scholar 

  65. El-Sheikha J, Nandhra S, Carradice D, Wallace T, Samuel N, Smith GE, et al. Clinical outcomes and quality of life 5 years after a randomized trial of concomitant or sequential phlebectomy following endovenous laser ablation for varicose veins. Br J Surg. 2014;101(9):1093–7.

    Article  CAS  PubMed  Google Scholar 

  66. Monahan DL. From the American Venous Forum: can phlebectomy be deferred in the treatment of varicose veins? J Vasc Surg. 2005;42:1145–9.

    Article  PubMed  Google Scholar 

  67. Nicolini P, Closure Group. Treatment of primary varicose veins by endovenous obliteration with the VNUS closure system: results of a prospective multicentre study. Eur J Vasc Endovasc Surg. 2005;29:443–9. 11

    Article  Google Scholar 

  68. Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg. 2002;28:38–42.

    PubMed  Google Scholar 

  69. Welch HJ. From the American Venous Forum: endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins. J Vasc Surg. 2006;44(3):601–5.

    Article  PubMed  Google Scholar 

  70. Walsh JC, Bergan JJ, Beeman S, Comer TP. Femoral venous reflux abolished by greater saphenous vein stripping. Ann Vasc Surg. 1994;8:566–70.

    Article  CAS  PubMed  Google Scholar 

  71. Sales CM, Bilof ML, Petrillo KA, Luka NL. Correction of lower extremity deep venous incompetence by ablation of superficial venous reflux. Ann Vasc Surg. 1996;10:186–9.

    Article  CAS  PubMed  Google Scholar 

  72. Wittens C, Davies AH, Baekgaard N, Broholm R, Cavezzi A, Chastanet S, et al. Management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49:678–737.

    Article  CAS  PubMed  Google Scholar 

  73. Labropoulos N, Patel PJ, Tiongson JE, Pryor L, Leon LR Jr, Tassiopoulous AK. Patterns of venous reflux and obstruction in patients with skin damage due to chronic venous disease. Vasc Endovasc Surg. 2007;41(1):33–40.

    Article  Google Scholar 

  74. Nicolaides AN, Hussein MK, Szendro G, Christopoulos D, Vasdekis S, Clarke H. The relationship of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg. 1993;17(2):414–9.

    Article  CAS  PubMed  Google Scholar 

  75. Nicolaides AN. Investigation of chronic venous insufficiency: a consensus statement. Circulation. 2000;102(20):1–38.

    Article  Google Scholar 

  76. Comerota AJ, Harada RN, Eze AR, et al. Air plethysmography: a clinical review. Int Angiol. 1995;14:45–52.

    CAS  PubMed  Google Scholar 

  77. Harada RN, Katz ML, Comerota A. A noninvasive screening test to detect “critical” deep venous reflux. J Vasc Surg. 1995;22(5):532–7.

    Article  CAS  PubMed  Google Scholar 

  78. Mussa FF, Peden EK, Zhou W, Lin PH, Lumsden AB, Bush RL. Iliac vein stenting for chronic venous insufficiency. Tex Heart Inst J. 2007;34(1):60–6.

    PubMed  PubMed Central  Google Scholar 

  79. Raju S, McAllister S, Neglen P. Recanalization of totally occluded iliac and adjacent venous segments. J Vasc Surg. 2002;36:903–11.

    Article  PubMed  Google Scholar 

  80. Raju S, Owen S Jr, Neglen P. The clinical impact of iliac venous stents in the management of chronic venous insufficiency. J Vasc Surg. 2002;35:8–15.

    Article  PubMed  Google Scholar 

  81. Hartung O, Otero A, Boufi M, De Caridi G, Barthelemy P, Juhan C, et al. Mid-term results of endovascular treatment for symptomatic chronic nonmalignant iliocaval venous occlusive disease. J Vasc Surg. 2005;52(6):1138–44.

    Article  Google Scholar 

  82. Raju S, Easterwood L, Fountain T, et al. Saphenectomy in the presence of chronic venous obstruction. Surgery. 1998;123:637–44.

    Article  CAS  PubMed  Google Scholar 

  83. Masuda EM, Kessler DM, Lurie F, et al. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg. 2006;43:551–6.

    Article  PubMed  Google Scholar 

  84. Koo S, Chieh-Min F. Pelvic congestion syndrome and pelvic varicosities. Tech Vasc Interv Radiol. 2014;178(2):90–5.

    Article  Google Scholar 

  85. Edwards RD, Robertson IR, MacLean AB, Hemingway AP. Case report: pelvic pain syndrome – successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993;47:429–31.

    Article  CAS  PubMed  Google Scholar 

  86. O’Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphatic Disord. 2015;3(1):96–106.

    Article  Google Scholar 

  87. Castenmiller PH, de Leur K, de Jong TE, van der Laan L. Clinical results after coil embolization of the ovarian vein in patients with primary and recurrent lower-limb varices with respect to vulval varices. Phlebology. 2013;28(5):234–8.

    Article  CAS  PubMed  Google Scholar 

  88. Baskerville PA, Ackroyd JS, Lea Thomas M, Browse NL. The Klippel-Trenaunay syndrome: clinical, radiological and hemodynamic features and management. Br J Surg. 1985;72:232–6.

    Article  CAS  PubMed  Google Scholar 

  89. Jacob AG, Driscoll DJ, Shaughnessy WJ, Stanson AW, Clay RP, Gloviczki P. Klippel-Trenaunay syndrome: spectrum and management. Mayo Clin Proc. 1998;73:28–36.

    Article  CAS  PubMed  Google Scholar 

  90. Gloviczki P, Driscoll DJ. Klippel-Trenaunay syndrome: current management. Phlebology. 2007;22(6):291–8.

    Article  CAS  PubMed  Google Scholar 

  91. Frasier K, Giangola G, Rosen R, Ginat DT. Endovascular radiofrequency ablation: a novel treatment of venous insufficiency in Klippel-Trenaunay patients. J Vasc Surg. 2008;47(6):1339–45.

    Article  PubMed  Google Scholar 

  92. Malgor RD, Gloviczki P, Fahmi J, Kalra M, Duncan AA, Oderich GS, et al. Surgical treatment of varicose veins and venous malformations in Klippel-Trenaunay syndrome. Phlebology. 2016;31(3):209–15.

    Article  PubMed  Google Scholar 

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Abi-Chaker, A.M., Aguirre, P.G.S., Almeida, J.I. (2018). Strategies to Treat Venous Reflux Disease. In: Chaar, C. (eds) Current Management of Venous Diseases . Springer, Cham. https://doi.org/10.1007/978-3-319-65226-9_15

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