更新于：2024-05-01

Fractures, Compression

压缩性骨折

更新于：2024-05-01

基本信息

别名

Compression Fracture、Compression Fractures、Compression fracture

+ [21]

简介

Crumbling or smashing of cancellous BONE by forces acting parallel to the long axis of bone. It is applied particularly to vertebral body fractures (SPINAL FRACTURES). (Blauvelt and Nelson, A Manual of Orthopedic Terminology, 1994, p4)

关联

132

项与压缩性骨折相关的临床试验

IRCT20200325046855N1 / Suspended临床4期IIT

Comparison of the clinical outcomes of percutaneous vertebroplasty vs. kyphoplasty for the treatment of osteoporotic Kümmell’s disease

开始日期2637-02-20

申办/合作机构

National Natural Science Foundation of China

ChiCTR2400080950 / RecruitingN/AIIT

Using MRI-based deep learning algorithms for accurate diagnosis of early-stage spinal tuberculosis and fresh vertebral compression fraMRIures.

开始日期2024-02-19

申办/合作机构

The Second Affiliated Hospital of Chongqing Medical University

NCT06093087 / Not yet recruiting临床1/2期

Internal Fixation Reconstruction With Stent Screw VS Balloon Kyphoplasty in the Treatment of Kummell's Disease: a Double Blinded Randomized Controlled Trial

This study is a multicenter, prospective, double-blind, randomized controlled trial using a parallel two-arm design to investigate whether the postoperative 6-month quality of life, vertebral stability, complication of patients with osteoporotic vertebral compression fractures (Kummell's disease) are better with the use of stent screw internal fixation and percutaneous bone cement reconstruction technique compared to patients undergoing traditional percutaneous balloon kyphoplasty (BKP) for vertebral augmentation

开始日期2024-01-01

申办/合作机构

浙江大学医学院附属第二医院

100 项与压缩性骨折相关的临床结果

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100 项与压缩性骨折相关的转化医学

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0 项与压缩性骨折相关的专利（医药）

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4,574

项与压缩性骨折相关的文献（医药）

2024-02-21·Orthopaedic surgery

Distal Junctional Failures in Degenerative Thoracolumbar Hyperkyphosis.

Article

作者: Yongqiang Wang ; Junyu Li ; Yu Xi ; Yan Zeng ; Miao Yu ; Zhuoran Sun ; Yinghong Ma ; Zhongjun Liu ; Zhongqiang Chen ; Weishi Li

OBJECTIVE:

Degenerative thoracolumbar hyperkyphosis (DTH) is a disease that negatively affects individual health and requires surgical intervention, yet the ideal surgical approach and complications, especially distal junctional failures (DJF), remain poorly understood. This study aims to investigate DJF in DTH and to identify the risk factors for DJF so that we can improve surgical decision-making, and advance our knowledge in the field of spinal surgery to enhance patient outcomes.

METHODS:

This study retrospectively reviewed 78 cases (late osteoporotic vertebral compression fracture [OVCF], 51; Scheuermann's kyphosis [SK], 17; and degenerative disc diseases [DDD], 10) who underwent corrective surgery in our institute from 2008 to 2019. Clinical outcomes were assessed using health-related quality of life (HRQOL) measures, including the visual analogue scale (VAS) scores for back and leg pain, the Oswestry disability index (ODI), and the Japanese Orthopaedic Association (JOA) scoring system. Multiple radiographic parameters, such as global kyphosis (GK) and thoracolumbar kyphosis (TLK), were assessed to determine radiographic outcomes. Multivariate logistic regression analysis was employed to identify the risk factors associated with DJF.

RESULTS:

HRQOL improved, and GK, TLK decreased at the final follow-up, with a correction rate of 67.7% and 68.5%, respectively. DJF was found in 13 of 78 cases (16.7%), two cases had wedging in the disc (L3-4) below the instrumentation, one case had a fracture of the lowest instrumented vertebrae (LIV), one case had osteoporotic fracture below the fixation, nine cases had pull-out or loosening of the screws at the LIV and three cases (23.1%) required revision surgery. The DJF group had older age, lower computed tomography Hounsfield unit (CT HU), longer follow-up, more blood loss, greater preoperative sagittal vertical axis (SVA), and poorer postoperative JOA and VAS scores (back). The change in TLK level was larger in the non-DJF group. Post-sagittal stable vertebrae (SSV) moved cranially compared with pre-SSV.

CONCLUSION:

Age, CT HU, length of follow-up, estimated blood loss, and preoperative SVA were independent risk factors for DJF. We recommend fixation of the two vertebrae below the apex vertebrae for DTH to minimize surgical trauma.

2024-02-21·International journal of radiation oncology, biology, physics

Stereotactic Body Radiotherapy (SBRT) for Sacral Metastases: Deviation from Recommended Target Volume Delineation Increases the Risk of Local Failure.

Article

作者: Daniel Moore-Palhares ; Kang Liang Zeng ; Chia-Lin Tseng ; Hanbo Chen ; Sten Myrehaug ; Hany Soliman ; Pejman Maralani ; Jeremie Larouche ; Husain Shakil ; Katarzyna Jerzak ; Mark Ruschin ; Beibei Zhang ; Eshetu G Atenafu ; Arjun Sahgal ; Jay Detsky

PURPOSE:

Although spine stereotactic body radiotherapy (SBRT) is considered a standard of care in the mobile spine, mature evidence reporting outcomes specific to sacral metastases is lacking. Furthermore, there is a need to validate the existing sacral SBRT international consensus contouring guidelines to define the optimal contouring approach. We report mature rates of local failure (LF), adverse events, and the impact of contouring deviations in the largest experience to date specific to sacrum SBRT.

METHODS/MATERIALS:

Consecutive patients who underwent sacral SBRT from 2010-2021 were retrospectively reviewed. Primary endpoint was magnetic resonance imaging-based LF with a specific focus on adherence to target volume contouring recommendations. Secondary endpoints included vertebral compression fracture (VCF) and neural toxicity.

RESULTS:

Of the 215 sacrum segments treated in 112 patients, most received 30 Gy/4 fractions (51%), 24 Gy/2 fractions (31%), or 30 Gy/5 fractions (10%). Sixteen percent of segments were non-adherent to the consensus guideline with a more restricted target volume (under-contoured). The median follow-up was 21.4 months (range, 1.5-116.9). The cumulative incidence of LF at 1 and 2 years was 18.4% and 23.1%, respectively. In those with guideline adherent vs. non-adherent contours, the LF rate at 1 year was 15.1% vs. 31.4% and at 2 years 18.8% vs. 40.0% (HR=2.5, 95% CI 1.4-4.6, p=0.003), respectively. On multivariable analysis, guideline non-adherence (HR=2.4, 95% CI 1.3-4.7, p=0.008), radioresistant histology (HR=2.4, 95% CI 1.4-4.1, p<0.001), and extraosseous extension (HR=2.5, 95% CI 1.3-4.7, p=0.005) predicted for an increased risk of LF. The cumulative incidence of VCF was 7.1% at 1 year and 12.3% at 2 years. Seven patients (6.3%) developed peripheral nerve toxicity, of which 4/7 had been previously radiated.

CONCLUSIONS:

Sacral SBRT is associated with high efficacy rates and an acceptable toxicity profile. Adhering to consensus guidelines for target volume delineation is recommended to reduce the risk of LF.

2024-02-19·American journal of clinical oncology

Early Experience With Two-Fraction Spine Stereotactic Body Radiation Therapy in Treating Spinal Metastases.

Article

作者: Ifeanyi O Ekpunobi ; Shearwood McClelland

INTRODUCTION:

Spinal metastases are common in metastatic cancer, affecting around 40% of patients. The primary treatment involves radiation therapy, transitioning from conventional external beam radiation therapy (EBRT) to stereotactic body radiation therapy (SBRT) for its superior, durable response. While spine SBRT has gained popularity in the United States, Level I evidence supporting it over EBRT is limited to a Canadian trial using a 2-fraction SBRT regimen. We present our findings from one of the earliest US experiences of 2-fraction spine SBRT for spinal metastases.

METHODS:

A retrospective analysis of patients with metastatic spine cancer receiving 2-fraction spine SBRT at a single center was conducted. Patients received treatment based on Level 1 evidence (24 Gy in 2 fractions). Follow-up records were assessed for local control outcomes and toxicity.

RESULTS:

Twenty patients since August 2022 have been treated with 2-fraction spine SBRT. Most patients were treated at 1 (45%) or 2 (40%) spinal levels, with the thoracic (55%) and lumbar (50%) spine being the most common locations. Common primary sites included the lung (30%), breast (20%), esophagus (15%), and prostate (10%). The rate of local control was 100%, while the rate of vertebral compression fracture was 15%. No esophageal or bowel toxicity occurred, and no fractures required intervention.

CONCLUSIONS:

These findings suggest that 2-fraction spine SBRT is safe and effective, consistent with existing Level I evidence. Our local control rate exceeding 95% aligns with the literature, indicating the feasibility and achievability of implementing this approach in the United States over a short period of time.

项与压缩性骨折相关的新闻（医药）

2024-04-03

·美通社

国际骨髓瘤关爱月 | "奏响生命凯歌，医路相髓"全国科普公益系列活动

关注患者可长生存新趋势，建立慢病化全程管理新观念，为患者争取最大生存获益中国北京 2024年4月3日 /美通社/ -- 百济神州（纳斯达克代码：BGNE；香港联交所代码：06160；上交所代码：688235）是一家全球肿瘤创新公司，今日宣布，由中国抗癌协会科普专业委员会和中国抗癌协会血液肿瘤整合康复专委会共同主办、百济神州支持的"奏响生命凯歌，医路相髓"国际骨髓瘤关爱月全国科普公益系列活动已圆满结束。 "国际骨髓瘤关爱月"是由国际骨髓瘤基金会（IMF）于2009年3月首次设立，倡议医务人员、患者及相关护理人员行动起来，提升社会对骨髓瘤的认识。本届"奏响生命凯歌，医路相髓"国际骨髓瘤关爱月全国科普公益系列活动，分别在北京、上海、天津、重庆、成都、杭州、武汉、济南等十城陆续开展，旨在提高全国公众对多发性骨髓瘤的认识，呼吁各方关注多发性骨髓瘤可长生存的新趋势，建立慢病化全程管理的新观念，为患者争取最大生存获益。中国医学科学院血液病医院淋巴瘤诊疗中心主任、中国抗癌协会血液肿瘤整合康复专委会主任委员邱录贵教授表示："随着诊疗技术发展和创新药物的应用，多发性骨髓瘤治疗取得显著进展，已进入长生存、慢病化管理时代。各方亟需更新观念，推动疾病全程管理和整体治疗水平的提升，助力患者实现规范治疗和整合康复。我们期待通过本次系列科普宣传活动，在普及疾病知识的同时，推动行业为肿瘤患者的全程管理提供更好的服务与支持。" 多发性骨髓瘤作为血液系统第二大常见的恶性肿瘤 [1] ，好发于老年群体、临床诊断困难、不可治愈且终将面临复发。患者骨髓内浆细胞恶性增殖，分泌大量异常免疫球蛋白，俗称"坏蛋白"，常造成骨髓、骨骼、肾脏等相关器官的损害。此外，该疾病也被称之为"吃骨头的血液病"，很多初诊患者伴有溶骨性损害、骨质疏松和/或压缩性骨折等骨相关事件。百济神州总裁兼首席运营官吴晓滨博士表示："本着 ‘百创新药，济世惠民' 的初心，我们始终以患者为先，持续关注肿瘤患者的未尽之需，积极推动肿瘤慢病化全程管理。作为一家全球创新肿瘤创新公司，百济神州将继续与专家和患者一起努力，让患者在接受更高质量的治疗同时，提升长期生存质量，为患者和家属的生活带来积极的改变。" 关于多发性骨髓瘤多发性骨髓瘤（multiple myeloma，MM）是一种克隆浆细胞异常增殖的恶性疾病，在很多国家是血液系统第2位常见恶性肿瘤，多发于老年，目前仍无法治愈。MM常见的症状包括骨髓瘤相关器官功能损伤的表现，即"CRAB"症状［血钙增高（Calcium elevation）、肾功能损害（Renal insufficiency）、贫血（Anemia）、骨病（Bone disease）］以及继发淀粉样变性等相关表现 [2] 。多发性骨髓瘤（multiple myeloma，MM）是一种不可治愈且复发率高的肿瘤，在男性及较年长人群的发病率更高 [3] 。随着社会老龄化程度的加剧，中国MM呈现逐年增高趋势 [4] ，不仅给患者家庭带来沉重的疾病负担，也造成了极大的社会经济损失。关于百济神州百济神州是一家全球肿瘤创新公司，专注于为全世界的癌症患者研发创新抗肿瘤药物。通过强大的自主研发能力和外部战略合作，我们不断加速开发多元、创新的药物管线和产品组合，致力于为全球更多患者全面提升药物可及性和可负担性。在全球五大洲，我们有超过10,000人的团队，并在中国北京、美国麻省剑桥和瑞士巴塞尔设立了主要办事处。如需了解更多信息，请访问www.beigene.com.cn或关注"百济神州"微信公众号。 [1] https://www.dzrmyy.cn/d/file/content/2022/05/62731b168b6af.pdf [2] https://www.dzrmyy.cn/d/file/content/2022/05/62731b168b6af.pdf [3] 2011年《中国药物与临床》 [4] 《2018年WHO全球肿瘤调研报告》

引进/卖出

2023-12-22

·生物谷

德谷胰岛素利拉鲁肽注射液：长病程控糖新选择

对于接受胰岛素联合其他药物治疗血糖不达标的长病程、年龄较大、伴有并发症的心血管高危老年T2DM患者，可考虑将IDegLira作为转换治疗方案的选择之一。 T2DM的三级预防目标是延缓已存在的糖尿病并发症的进展、降低致残率和死亡率，改善患者的生存质量[1]。对于年龄较大，预期寿命较短，糖尿病病程较长，既往曾发生过严重低血糖或未察觉的低血糖，或有明显糖尿病并发症或严重合并症的患者，其血糖控制目标可适当放宽，避免发生低血糖事件[2]。选择降糖方案简单且低血糖风险小的药物，更有利于患者血糖的管理及生活质量的提高。厦门大学附属中山医院黄延玲医生分享了1例伴有糖尿病肾病的长病程老年T2DM患者，应用基础胰岛素联合多种口服降糖药物治疗血糖控制欠佳，后转换为德谷胰岛素利拉鲁肽注射液联合SGLT-2抑制剂治疗的诊治过程，以期为临床应用提供参考。案例分享患者，女，68岁，主因“口干、多饮、多尿16年，下肢浮肿1月”入院现病史：患者16年前无明显诱因出现“口干、多饮、多尿”症状，就诊当地医院，查静脉空腹血糖明显升高（具体不详），诊断为“2型糖尿病”，予以“二甲双胍、格列齐特缓释片”降糖治疗，初期血糖控制尚可，监测末梢空腹血糖6-7mmol/L，餐后2小时血糖10-12mmol/L。3年前摔跤，腰椎压缩性骨折，住院期间查血糖升高，加用地特胰岛素16u 22：00皮下注射，出院后监测末梢空腹血糖：7-8mmol/L，餐后血糖未监测。半年前新冠感染后再次出现血糖控制欠佳，自行逐渐将地特胰岛素加量，目前地特胰岛素用量为24u 22：00皮下注射。1月前发现下肢浮肿，晨轻暮重，伴小便泡沫增多，视物模糊，就诊我院，查静脉空腹血糖：9.6mmol/L。尿常规提示：尿糖：3+，尿蛋白：2+。本次发病以来，精神、食欲、睡眠欠佳。现为求进一步诊治，就诊我科。既往史：有高血压病史20年，目前服用缬沙坦氨氯地平1片 qd降压治疗，血压控制欠佳。否认“冠心病，脑卒中”等病史，否认“肝炎、结核、伤寒”病史。否认输血史，否认食物、药物过敏史。个人史：否认烟酒等不良嗜好。婚育史：已婚，育1子，配偶、子均健康。家族史：父亲及1兄有糖尿病病史。体格检查：T：36.6°C，R：20次/分，P：78次分；BP：148/86mmHg。神志清楚，发育正常，营养中等，身高：158cm，体重：67kg，BMI：26.8kg/m2，表情自如，体位自主，查体合作。甲状腺无肿大，未触及结节及震颤，未闻及血管杂音。胸廓无畸形。双肺呼吸音清晰，未闻及干湿性罗音，心率：78次/分，律齐，各瓣膜听诊区未闻及干湿性罗音，服软，肝脾肋下未触及，双下肢轻度凹陷性浮肿，足部皮肤完整，病理征未引出。实验室检查：血常规：白细胞计数8..67×109/L，红细胞计数4.59×1012/L，血红蛋白130g/L。血生化：总蛋白70.6g/L，白蛋白33.1g/L，丙氨酸氨基转移酶39.9U/L，天门冬氨酸氨基转移酶44.8/L4，β-轻基丁酸0.32mmol/L，TC 6.2mmol/L，HDL-C 0.92mmol/L，LDL-C 4.47mmol/L，葡萄糖 9.61mmol/L，eGFR 78.3mL/min/1.73m2，BUN 6.73mmol/L，肌酐84.3umol/L，钾 4.06mmol/L，钠 135.1mmol/L，氯95.0mmol/L，D-二聚体 0.37mg/L，BNP 620ng/L，糖化白蛋白 26.00%。甲功六项正常，HbA1c 8.2%。糖尿病自身抗体谱：抗谷酸脱酶抗体阴性、抗胰岛细胞抗体阴性、抗胰岛素抗体阴性。尿常规：尿糖：3+，尿蛋白定性2+，尿胆原 1+。 C肽释放试验：C肽(空腹): 0.381 nmol/L, (60分钟)：0.962 nmol/L, (120分钟)：1.336nmol/L。尿微量白蛋白/尿肌酐961.1mg/g，24小时尿蛋白定量1990mg/day，24小时尿微量白蛋白1832mg/day。辅助检查：入院诊断： 1、2型糖尿病，糖尿病性肾病IV期，糖尿病视网膜病变IV期，外周动脉粥样硬化；2、高血压病（3级很高危）；3、高脂血症。治疗方案：调整降糖方案为：德谷胰岛素利拉鲁肽注射液（IDegLira） 24u 早餐前皮下注射，达格列净10mg qd，格列齐特缓释片60mg qd，并加用非奈利酮减少尿蛋白治疗，患者同时血压控制欠佳，改缬沙坦氨氯地平为沙库巴曲缬沙坦100mg bid，并加用阿托伐他汀20mg qd，阿司匹林肠溶片100mg qd 调脂稳定斑块治疗，患者血糖、血压控制较前明显改善，逐步停用格列齐特缓释片及二甲双胍，仅用IDegLira联合达格列净治疗，血糖控制良好，下肢浮肿在治疗方案改变后明显消退。1月后复诊，尿微量白蛋白/肌酐下降至356mg/g。表1. 患者降糖治疗方案调整及血糖控制情况案例解析本例患者为老年T2DM患者，超重，病程长，伴有高血压、血脂异常和外周动脉粥样硬化，且已出现微血管并发症——糖尿病肾病（DKD）和糖尿病视网膜病变（DR），指南强调，对于该类患者，应继续采取降糖、降压、调脂（主要是降低LDL‑C）、抗血小板治疗和控制体重等综合管理措施，以降低心血管事件、微血管并发症进展及死亡的风险[1]。严格控制血糖虽可降低糖尿病微血管病变（如非增殖性视网膜病变、微量白蛋白尿等）进一步发展的风险，但同时应避免低血糖风险增加。2024 ADA指南推荐，为了最大程度地降低胰岛素治疗时低血糖的风险和治疗负担，建议重新评估低血糖风险较高的降糖药（即胰岛素促泌剂）的需求和/或剂量[3]。因此，该患者在治疗中逐步停用格列齐特缓释片。研究发现，对于基础胰岛素治疗血糖控制不佳的患者，转换为IDegLira治疗与基础‑餐时胰岛素方案降糖疗效相当[4]，低血糖风险低，并减轻体重。对DUAL Ⅱ 、DUAL Ⅴ、DUAL Ⅶ研究的事后分析显示，既往基础胰岛素治疗血糖控制不佳的患者，转换为IDegLira较基础胰岛素或基础‑餐时胰岛素方案可改善SBP、HDL-C和LDL-C等心血管危险因素，同时减轻体重[5]。因此，将地特胰岛素更换为IDegLira有助于在提高疗效的同时减少低血糖风险，避免胰岛素治疗带来的体重增加等不良反应，达到安全控糖的目的。综上，对于接受胰岛素联合其他药物治疗血糖不达标的长病程、年龄较大、伴有并发症的心血管高危老年T2DM患者，可考虑将IDegLira作为转换治疗方案的选择之一。参考文献 [1]中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志,2021,13(4):315-409. [2]王卫庆, 王育璠, 王桂侠, 等. 国家标准化代谢性疾病管理中心(MMC)代谢病管理指南(第二版) [J]. 中华内分泌代谢杂志, 2023, 6:538-554. DOI:10.3760/cma.j.cn311282-20230216-00072. [3] American Diabetes Association Professional Practice Committee. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024[J]. Diabetes Care, 2024, 47(Suppl 1):S158-S178. DOI: 10.2337/dc24-S009. [4] Billings LK, Doshi A, Gouet D, et al. Efficacy and safety of IDegLira versus basal‑bolus insulin therapy in patients with type 2 diabetes uncontrolled on metformin and basal insulin: the DUAL Ⅶ randomized clinical trial[J].Diabetes Care, 2018, 41(5): 1009‑1016. DOI: 10.2337/dc17‑1114. [5] Vilsbøll T, Blevins TC, Jodar E, et al. Fixed‑ratio combination of insulin degludec and liraglutide (IDegLira) improves cardiovascular risk markers in patients with type 2 diabetes uncontrolled on basal insulin[J]. Diabetes Obes Metab, 2019, 21(6):1506‑1512.DOI: 10.1111/dom.13675. 作者简介黄延玲 •厦门大学附属中山医院内分泌科 •副主任医师硕导 •福建省医师协会内分泌学分会委员 •厦门医学会糖尿病学分会常委 •厦门医学会内分泌学分会委员

临床结果临床研究

2023-11-30

·Business Wire

Memphis Vascular Center Opens New Outpatient Diagnostic and Treatment Facility

MEMPHIS, Tenn.--( BUSINESS WIRE )--Memphis Vascular Center (MVC), a medical practice specializing in vascular and interventional radiology, has opened a new outpatient center to serve patients throughout the Memphis area. The center’s doctors provide high quality diagnostic and minimally invasive treatment for vascular disease, cancer and other health conditions. “Interventional radiology is rapidly becoming the standard of care for treating certain health issues that once required surgery,” says MVC medical director and interventional radiologist Scott Osborne, M.D. “Thanks to our new center, patients can be treated in an outpatient setting, where convenience and exceptional care are the priority. Other benefits include a lower risk of hospital-acquired infections and lower overall cost.” The new center houses a combination of state-of-the-art diagnostic imaging equipment and treatment rooms. The treatments are performed by a team of interventional radiologists, doctors who specialize in using imaging to perform minimally invasive treatments for various conditions. “The solutions we offer are some of the most highly advanced medical procedures available today,” Dr. Osborne adds. “For example, fibroids within the uterus affect about 40% of women over 35. Each year, hundreds of thousands of women undergo hysterectomy or myomectomy to treat their fibroids. However, surgically removing fibroids from the uterus—or removing the uterus itself—is no longer required to treat this condition. With interventional radiology, we block or ‘embolize’ the blood vessels that feed the fibroid. Without a blood supply, the fibroids shrink and symptoms disappear. No open surgery required, no scarring, very little recovery time and lasting results.” Conditions treated at the new center include:: Peripheral arterial disease (PAD) and critical limb ischemia (CLI) Varicose veins Liver cancer Uterine fibroids Enlarged prostate causing urinary trouble Knee pain from osteoarthritis Chronic bleeding hemorrhoids Spinal compression fractures All procedures offered are FDA-cleared. They are virtually pain-free, and do not require general anesthesia. In most cases, patients can return home the same day as their procedure and resume normal activities shortly thereafter. About Memphis Vascular Center The doctors of Memphis Vascular Center are among the region’s most experienced specializing in the minimally invasive treatment of diseases and health conditions. Vascular and interventional radiology is a method of treating disease from inside the body, without open surgery. This results in less trauma for the patient, lower risk of complications, shorter recovery time and virtually no scarring. Additionally, these treatments are performed in our outpatient center, a safe and convenient alternative to a hospital. Our doctors are fellowship trained in vascular and interventional radiology. With more than 13 years of education, they are among the most highly trained doctors practicing medicine and are uniquely qualified to provide both diagnostic evaluations as well as the required treatment. MemphisVascular.com