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Published in: Current Treatment Options in Cardiovascular Medicine 2/2012

01-04-2012 | Vascular Disease (H Gornik and E Kim, Section Editors)

Update on the Biology and Treatment of Lymphedema

Author: Stanley G. Rockson, MD

Published in: Current Treatment Options in Cardiovascular Medicine | Issue 2/2012

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Opinion statement

The past decade has produced an explosion of insights into lymphatic vascular development and structural biology and, in parallel, into the function of the lymphatics in health and in disease. In lymphedema, there is a spectrum that extends from primary (heritable) to acquired causes of disease. The diagnosis of lymphatic edema implicates a very specific treatment approach that is predicated upon the favorable impact of physiotherapy upon lymph flow and protein clearance from the edematous zones of the body. The recognition of the unique biology that accompanies lymphatic causes of edema has stimulated new research directions that are likely to translate into exciting new pharmacologic and molecular approaches to diagnosis and treatment.
Literature
2.
go back to reference Rockson SG. How can lymphatic research influence lymphatic education? Lymphat Res Biol. 2004;2(2):67–8.PubMedCrossRef Rockson SG. How can lymphatic research influence lymphatic education? Lymphat Res Biol. 2004;2(2):67–8.PubMedCrossRef
3.
go back to reference Rockson SG, Granger DN, Skeff KM, Chaite W. Lymphatic biology and disease: is it being taught? Who is listening? Lymphat Res Biol. 2004;2(2):86–95.PubMedCrossRef Rockson SG, Granger DN, Skeff KM, Chaite W. Lymphatic biology and disease: is it being taught? Who is listening? Lymphat Res Biol. 2004;2(2):86–95.PubMedCrossRef
4.••
go back to reference Rockson SG. Diagnosis and management of lymphatic vascular disease. J Am Coll Cardiol. 2008;52(10):799–806.PubMedCrossRef Rockson SG. Diagnosis and management of lymphatic vascular disease. J Am Coll Cardiol. 2008;52(10):799–806.PubMedCrossRef
5.•
go back to reference Norrmen C, Tammela T, Petrova TV, Alitalo K. Biological basis of therapeutic lymphangiogenesis. Circulation. 2011;123(12):1335–51.PubMedCrossRef Norrmen C, Tammela T, Petrova TV, Alitalo K. Biological basis of therapeutic lymphangiogenesis. Circulation. 2011;123(12):1335–51.PubMedCrossRef
8.
go back to reference Hodge LM, Downey HF. Lymphatic pump treatment enhances the lymphatic and immune systems. Exp Biol Med (Maywood). 2011;236(10):1109–15.CrossRef Hodge LM, Downey HF. Lymphatic pump treatment enhances the lymphatic and immune systems. Exp Biol Med (Maywood). 2011;236(10):1109–15.CrossRef
9.•
go back to reference Detry B, Bruyere F, Erpicum C, Paupert J, Lamaye F, Maillard C, Lenoir B, Foidart JM, Thiry M, Noel A. Digging deeper into lymphatic vessel formation in vitro and in vivo. BMC Cell Biol. 2011;12:29.PubMedCrossRef Detry B, Bruyere F, Erpicum C, Paupert J, Lamaye F, Maillard C, Lenoir B, Foidart JM, Thiry M, Noel A. Digging deeper into lymphatic vessel formation in vitro and in vivo. BMC Cell Biol. 2011;12:29.PubMedCrossRef
10.
go back to reference Nakamura K, Rockson SG. Molecular targets for therapeutic lymphangiogenesis in lymphatic dysfunction and disease. Lymphat Res Biol. 2008;6(3–4):181–9.PubMedCrossRef Nakamura K, Rockson SG. Molecular targets for therapeutic lymphangiogenesis in lymphatic dysfunction and disease. Lymphat Res Biol. 2008;6(3–4):181–9.PubMedCrossRef
11.
go back to reference An A, Rockson SG. The potential for molecular treatment strategies in lymphatic disease. Lymphat Res Biol. 2004;2(4):173–81.PubMedCrossRef An A, Rockson SG. The potential for molecular treatment strategies in lymphatic disease. Lymphat Res Biol. 2004;2(4):173–81.PubMedCrossRef
12.
go back to reference Ferrell RE, Kimak MA, Lawrence EC, Finegold DN. Candidate gene analysis in primary lymphedema. Lymphat Res Biol. 2008;6(2):69–76.PubMedCrossRef Ferrell RE, Kimak MA, Lawrence EC, Finegold DN. Candidate gene analysis in primary lymphedema. Lymphat Res Biol. 2008;6(2):69–76.PubMedCrossRef
13.
go back to reference Finegold DN, Schacht V, Kimak MA, Lawrence EC, Foeldi E, Karlsson JM, Baty CJ, Ferrell RE. HGF and MET mutations in primary and secondary lymphedema. Lymphat Res Biol. 2008;6(2):65–8.PubMedCrossRef Finegold DN, Schacht V, Kimak MA, Lawrence EC, Foeldi E, Karlsson JM, Baty CJ, Ferrell RE. HGF and MET mutations in primary and secondary lymphedema. Lymphat Res Biol. 2008;6(2):65–8.PubMedCrossRef
14.
go back to reference Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999;177(3):184–7. discussion 188.PubMedCrossRef Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999;177(3):184–7. discussion 188.PubMedCrossRef
15.
16.
go back to reference Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44(1):43–57.PubMed Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44(1):43–57.PubMed
17.
go back to reference Szuba A, Skobe M, Karkkainen MJ, Shin WS, Beynet DP, Rockson NB, Dakhil N, Spilman S, Goris ML, Strauss HW, Quertermous T, Alitalo K, Rockson SG. Therapeutic lymphangiogenesis with human recombinant VEGF-C. FASEB J. 2002;(in press). Szuba A, Skobe M, Karkkainen MJ, Shin WS, Beynet DP, Rockson NB, Dakhil N, Spilman S, Goris ML, Strauss HW, Quertermous T, Alitalo K, Rockson SG. Therapeutic lymphangiogenesis with human recombinant VEGF-C. FASEB J. 2002;(in press).
18.
go back to reference Tabibiazar R, Cheung L, Han J, Swanson J, Beilhack A, An A, Dadras SS, Rockson N, Joshi S, Wagner R, Rockson SG. Inflammatory manifestations of experimental lymphatic insufficiency. PLoS Med. 2006;3(7):e254.PubMedCrossRef Tabibiazar R, Cheung L, Han J, Swanson J, Beilhack A, An A, Dadras SS, Rockson N, Joshi S, Wagner R, Rockson SG. Inflammatory manifestations of experimental lymphatic insufficiency. PLoS Med. 2006;3(7):e254.PubMedCrossRef
19.
go back to reference Avraham T, Daluvoy S, Zampell J, Yan A, Haviv YS, Rockson SG, Mehrara BJ. Blockade of transforming growth factor-beta1 accelerates lymphatic regeneration during wound repair. Am J Pathol. 2010;177(6):3202–14.PubMedCrossRef Avraham T, Daluvoy S, Zampell J, Yan A, Haviv YS, Rockson SG, Mehrara BJ. Blockade of transforming growth factor-beta1 accelerates lymphatic regeneration during wound repair. Am J Pathol. 2010;177(6):3202–14.PubMedCrossRef
20.•
go back to reference Zampell JC, Yan A, Avraham T, Andrade V, Malliaris S, Aschen S, Rockson SG, Mehrara BJ. Temporal and spatial patterns of endogenous danger signal expression after wound healing and in response to lymphedema. Am J Physiol Cell Physiol. May;300(5):C1107–1121. This is an animal study that underscores the importance of tissue injury responses as an integral component of the biology of lymphedema. Zampell JC, Yan A, Avraham T, Andrade V, Malliaris S, Aschen S, Rockson SG, Mehrara BJ. Temporal and spatial patterns of endogenous danger signal expression after wound healing and in response to lymphedema. Am J Physiol Cell Physiol. May;300(5):C1107–1121. This is an animal study that underscores the importance of tissue injury responses as an integral component of the biology of lymphedema.
21.
go back to reference Beilhack A, Rockson SG. Immune traffic: a functional overview. Lymphat Res Biol. 2003;1(3):219–34.PubMedCrossRef Beilhack A, Rockson SG. Immune traffic: a functional overview. Lymphat Res Biol. 2003;1(3):219–34.PubMedCrossRef
22.
go back to reference Johnson LA, Jackson DG. Cell traffic and the lymphatic endothelium. Ann N Y Acad Sci. 2008;1131:119–33.PubMedCrossRef Johnson LA, Jackson DG. Cell traffic and the lymphatic endothelium. Ann N Y Acad Sci. 2008;1131:119–33.PubMedCrossRef
23.
go back to reference Wigle JT, Harvey N, Detmar M, Lagutina I, Grosveld G, Gunn MD, Jackson DG, Oliver G. An essential role for Prox1 in the induction of the lymphatic endothelial cell phenotype. EMBO J. 2002;21(7):1505–13.PubMedCrossRef Wigle JT, Harvey N, Detmar M, Lagutina I, Grosveld G, Gunn MD, Jackson DG, Oliver G. An essential role for Prox1 in the induction of the lymphatic endothelial cell phenotype. EMBO J. 2002;21(7):1505–13.PubMedCrossRef
24.
go back to reference Wigle JT, Oliver G. Prox1 function is required for the development of the murine lymphatic system. Cell. 1999;98(6):769–78.PubMedCrossRef Wigle JT, Oliver G. Prox1 function is required for the development of the murine lymphatic system. Cell. 1999;98(6):769–78.PubMedCrossRef
25.
go back to reference Harvey NL, Srinivasan RS, Dillard ME, Johnson NC, Witte MH, Boyd K, Sleeman MW, Oliver G. Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity. Nat Genet. 2005;37(10):1072–81.PubMedCrossRef Harvey NL, Srinivasan RS, Dillard ME, Johnson NC, Witte MH, Boyd K, Sleeman MW, Oliver G. Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity. Nat Genet. 2005;37(10):1072–81.PubMedCrossRef
26.
go back to reference Brorson H, Ohlin K, Olsson G, Karlsson M. Breast cancer-related chronic arm lymphedema is associated with excess adipose and muscle tissue. Lymphat Res Biol. 2009;7(1). Brorson H, Ohlin K, Olsson G, Karlsson M. Breast cancer-related chronic arm lymphedema is associated with excess adipose and muscle tissue. Lymphat Res Biol. 2009;7(1).
27.
go back to reference Brorson H, Ohlin K, Olsson G, Langstrom G, Wiklund I, Svensson H. Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology. 2006;39(1):8–25.PubMed Brorson H, Ohlin K, Olsson G, Langstrom G, Wiklund I, Svensson H. Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology. 2006;39(1):8–25.PubMed
28.
go back to reference Brorson H. Liposuction in arm lymphedema treatment. Scand J Surg. 2003;92(4):287–95.PubMed Brorson H. Liposuction in arm lymphedema treatment. Scand J Surg. 2003;92(4):287–95.PubMed
29.
go back to reference Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg. 1998;102(4):1058–67. discussion 1068.PubMedCrossRef Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg. 1998;102(4):1058–67. discussion 1068.PubMedCrossRef
30.
go back to reference Cheung L, Han J, Beilhack A, Joshi S, Wilburn P, Dua A, An A, Rockson SG. An experimental model for the study of lymphedema and its response to therapeutic lymphangiogenesis. BioDrugs. 2006;20(6):363–70.PubMedCrossRef Cheung L, Han J, Beilhack A, Joshi S, Wilburn P, Dua A, An A, Rockson SG. An experimental model for the study of lymphedema and its response to therapeutic lymphangiogenesis. BioDrugs. 2006;20(6):363–70.PubMedCrossRef
31.
go back to reference Schneider M, Ny A, Ruiz de Almodovar C, Carmeliet P. A new mouse model to study acquired lymphedema. PLoS Med. 2006;3(7):e264.PubMedCrossRef Schneider M, Ny A, Ruiz de Almodovar C, Carmeliet P. A new mouse model to study acquired lymphedema. PLoS Med. 2006;3(7):e264.PubMedCrossRef
32.
go back to reference Jin D, An A, Liu J, Nakamura K, Rockson S. Therapeutic Responses to Exogenous VEGF-C Administration in Experimental Lymphedema: Immunohistochemical and Molecular Characterization Lymphat Res Biol. 2009;7(1). Jin D, An A, Liu J, Nakamura K, Rockson S. Therapeutic Responses to Exogenous VEGF-C Administration in Experimental Lymphedema: Immunohistochemical and Molecular Characterization Lymphat Res Biol. 2009;7(1).
33.
go back to reference Lahteenvuo M, Honkonen K, Tervala T, Tammela T, Suominen E, Lahteenvuo J, Kholova I, Alitalo K, Yla-Herttuala S, Saaristo A. Growth factor therapy and autologous lymph node transfer in lymphedema. Circulation. 2011;123(6):613–20.PubMedCrossRef Lahteenvuo M, Honkonen K, Tervala T, Tammela T, Suominen E, Lahteenvuo J, Kholova I, Alitalo K, Yla-Herttuala S, Saaristo A. Growth factor therapy and autologous lymph node transfer in lymphedema. Circulation. 2011;123(6):613–20.PubMedCrossRef
34.
go back to reference Van der Auwera I, Cao Y, Tille JC, Pepper MS, Jackson DG, Fox SB, Harris AL, Dirix LY, Vermeulen PB. First international consensus on the methodology of lymphangiogenesis quantification in solid human tumours. Br J Cancer. 2006;95(12):1611–25.PubMedCrossRef Van der Auwera I, Cao Y, Tille JC, Pepper MS, Jackson DG, Fox SB, Harris AL, Dirix LY, Vermeulen PB. First international consensus on the methodology of lymphangiogenesis quantification in solid human tumours. Br J Cancer. 2006;95(12):1611–25.PubMedCrossRef
35.
go back to reference Cornish B. Bioimpedance analysis: scientific background. Lymphat Res Biol Spring. 2006;4(1):47–50.CrossRef Cornish B. Bioimpedance analysis: scientific background. Lymphat Res Biol Spring. 2006;4(1):47–50.CrossRef
36.
go back to reference Ward LC. Bioelectrical impedance analysis: proven utility in lymphedema risk assessment and therapeutic monitoring. Breast Cancer Res Treat. 2006;4(1):51–6. Ward LC. Bioelectrical impedance analysis: proven utility in lymphedema risk assessment and therapeutic monitoring. Breast Cancer Res Treat. 2006;4(1):51–6.
37.
go back to reference Szuba A, Cooke JP, Yousuf S, Rockson SG. Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema. Am J Med. 2000;109(4):296–300.PubMedCrossRef Szuba A, Cooke JP, Yousuf S, Rockson SG. Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema. Am J Med. 2000;109(4):296–300.PubMedCrossRef
38.
go back to reference Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–73.PubMedCrossRef Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–73.PubMedCrossRef
39.
go back to reference Szuba A, Razavi M, Rockson SG. Diagnosis and treatment of concomitant venous obstruction in patients with secondary lymphedema. J Vasc Interv Radiol. 2002;13(8):799–803.PubMedCrossRef Szuba A, Razavi M, Rockson SG. Diagnosis and treatment of concomitant venous obstruction in patients with secondary lymphedema. J Vasc Interv Radiol. 2002;13(8):799–803.PubMedCrossRef
40.
go back to reference Raju S, Furrh JBt, Neglen P. Diagnosis and treatment of venous lymphedema. 2011; J Vasc Surg. Sep 27 [Epub ahead of print]. Raju S, Furrh JBt, Neglen P. Diagnosis and treatment of venous lymphedema. 2011; J Vasc Surg. Sep 27 [Epub ahead of print].
41.
go back to reference Damstra RJ, Voesten HG, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat. 2009;113(2):199–206.PubMedCrossRef Damstra RJ, Voesten HG, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat. 2009;113(2):199–206.PubMedCrossRef
42.
go back to reference Weiss M, Baumeister RG, Hahn K. Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study. Eur J Nucl Med Mol Imaging. 2003;30(2):202–6.PubMedCrossRef Weiss M, Baumeister RG, Hahn K. Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study. Eur J Nucl Med Mol Imaging. 2003;30(2):202–6.PubMedCrossRef
43.
go back to reference Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. World J Surg. 2004;28(6):609–13.PubMedCrossRef Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. World J Surg. 2004;28(6):609–13.PubMedCrossRef
44.
go back to reference Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg. 2006;243(3):313–5.PubMedCrossRef Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg. 2006;243(3):313–5.PubMedCrossRef
45.
go back to reference Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Reconstr Surg Hand Surg. 1997;31(2):137–43.PubMedCrossRef Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Reconstr Surg Hand Surg. 1997;31(2):137–43.PubMedCrossRef
46.
go back to reference McGeown JG, McHale NG, Thornbury KD. Effects of varying patterns of external compression on lymph flow in the hindlimb of the anaesthetized sheep. J Physiol. 1988;397:449–57.PubMed McGeown JG, McHale NG, Thornbury KD. Effects of varying patterns of external compression on lymph flow in the hindlimb of the anaesthetized sheep. J Physiol. 1988;397:449–57.PubMed
47.
go back to reference Szuba A, Achalu R, Rockson SG. Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer. 2002;95(11):2260–7.PubMedCrossRef Szuba A, Achalu R, Rockson SG. Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer. 2002;95(11):2260–7.PubMedCrossRef
48.
go back to reference Wilburn O, Wilburn P, Rockson SG. A pilot, prospective evaluation of a novel alternative for maintenance therapy of breast cancer-associated lymphedema [ISRCTN76522412]. BMC Cancer. 2006;6:84.PubMedCrossRef Wilburn O, Wilburn P, Rockson SG. A pilot, prospective evaluation of a novel alternative for maintenance therapy of breast cancer-associated lymphedema [ISRCTN76522412]. BMC Cancer. 2006;6:84.PubMedCrossRef
49.
go back to reference Rockson SG. Current concepts and future directions in the diagnosis and management of lymphatic vascular disease. Vasc Med. 2010;15(3):223–31.PubMedCrossRef Rockson SG. Current concepts and future directions in the diagnosis and management of lymphatic vascular disease. Vasc Med. 2010;15(3):223–31.PubMedCrossRef
50.
go back to reference Karkkainen MJ, Saaristo A, Jussila L, Karila KA, Lawrence EC, Pajusola K, Bueler H, Eichmann A, Kauppinen R, Kettunen MI, Yla-Herttuala S, Finegold DN, Ferrell RE, Alitalo K. A model for gene therapy of human hereditary lymphedema. Proc Natl Acad Sci U S A. 2001;98(22):12677–82.PubMedCrossRef Karkkainen MJ, Saaristo A, Jussila L, Karila KA, Lawrence EC, Pajusola K, Bueler H, Eichmann A, Kauppinen R, Kettunen MI, Yla-Herttuala S, Finegold DN, Ferrell RE, Alitalo K. A model for gene therapy of human hereditary lymphedema. Proc Natl Acad Sci U S A. 2001;98(22):12677–82.PubMedCrossRef
51.
go back to reference Karkkainen MJ, Ferrell RE, Lawrence EC, Kimak MA, Levinson KL, McTigue MA, Alitalo K, Finegold DN. Missense mutations interfere with VEGFR-3 signalling in primary lymphoedema. Nat Genet. 2000;25(2):153–9.PubMedCrossRef Karkkainen MJ, Ferrell RE, Lawrence EC, Kimak MA, Levinson KL, McTigue MA, Alitalo K, Finegold DN. Missense mutations interfere with VEGFR-3 signalling in primary lymphoedema. Nat Genet. 2000;25(2):153–9.PubMedCrossRef
52.
go back to reference Fang J, Dagenais SL, Erickson RP, Arlt MF, Glynn MW, Gorski JL, Seaver LH, Glover TW. Mutations in FOXC2 (MFH-1), a forkhead family transcription factor, are responsible for the hereditary lymphedema-distichiasis syndrome [in process citation]. Am J Hum Genet. 2000;67(6):1382–8.PubMedCrossRef Fang J, Dagenais SL, Erickson RP, Arlt MF, Glynn MW, Gorski JL, Seaver LH, Glover TW. Mutations in FOXC2 (MFH-1), a forkhead family transcription factor, are responsible for the hereditary lymphedema-distichiasis syndrome [in process citation]. Am J Hum Genet. 2000;67(6):1382–8.PubMedCrossRef
53.
go back to reference Irrthum A, Devriendt K, Chitayat D, Matthijs G, Glade C, Steijlen PM, Fryns JP, Van Steensel MA, Vikkula M. Mutations in the transcription factor gene SOX18 underlie recessive and dominant forms of hypotrichosis-lymphedema-telangiectasia. Am J Hum Genet. 2003;72(6):1470–8.PubMedCrossRef Irrthum A, Devriendt K, Chitayat D, Matthijs G, Glade C, Steijlen PM, Fryns JP, Van Steensel MA, Vikkula M. Mutations in the transcription factor gene SOX18 underlie recessive and dominant forms of hypotrichosis-lymphedema-telangiectasia. Am J Hum Genet. 2003;72(6):1470–8.PubMedCrossRef
Metadata
Title
Update on the Biology and Treatment of Lymphedema
Author
Stanley G. Rockson, MD
Publication date
01-04-2012
Publisher
Current Science Inc.
Published in
Current Treatment Options in Cardiovascular Medicine / Issue 2/2012
Print ISSN: 1092-8464
Electronic ISSN: 1534-3189
DOI
https://doi.org/10.1007/s11936-012-0170-0

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