Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score
Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five in...
Gespeichert in:
Veröffentlicht in: | Journal of vascular surgery 2007-11, Vol.46 (5), p.991-996 |
---|---|
Hauptverfasser: | , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 996 |
---|---|
container_issue | 5 |
container_start_page | 991 |
container_title | Journal of vascular surgery |
container_volume | 46 |
creator | Carpentier, Patrick H., MD Poulain, Caroline, MD Fabry, Régine, PhD Chleir, Franck, MD Guias, Bruno, MD Bettarel-Binon, Catherine, MD |
description | Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of >3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions |
doi_str_mv | 10.1016/j.jvs.2007.06.044 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68473032</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0741521407011226</els_id><sourcerecordid>68473032</sourcerecordid><originalsourceid>FETCH-LOGICAL-c479t-119cb099c6e23f943b24d17e91468600203d88390c9d5b1f26ffe9baad0d678e3</originalsourceid><addsrcrecordid>eNp9kUGL1DAYhoMo7rj6A7xIL3pr_ZJ2kkZhYVlcFRY8uF68hDT5OpvaacZ87cD8ezPMsIIHT7k878uX52XsNYeKA5fvh2rYUyUAVAWygqZ5wlYctCplC_opW4FqeLkWvLlgL4gGAM7XrXrOLrjSLYh2vWI_r8ml0IVpU4y4Keiw3c1xS8UcC_eQ4hRcsccpLlT4QDF5TPShuH_AwsWJ5rS4OcSpiH1hM2A3U6Q5R8jFhC_Zs96OhK_O7yX7cfvp_uZLefft89eb67vSNUrPJefadaC1kyjqXjd1JxrPFWreyFYCCKh929YanPbrjvdC9j3qzloPXqoW60v27tS7S_H3gjSbbSCH42gnzIcb2TaqhlpkkJ9AlyJRwt7sUtjadDAczFGoGUwWao5CDUiThebMm3P50m3R_02cDWbg7Rmw5OzYJzu5QI9c7sqf0DxzH08cZhX7gMmQCzg59CGhm42P4b9nXP2TdmPI49jxFx6QhrikKTs23JAwYL4flz8ODypvLoSs_wC9kqhz</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>68473032</pqid></control><display><type>article</type><title>Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Carpentier, Patrick H., MD ; Poulain, Caroline, MD ; Fabry, Régine, PhD ; Chleir, Franck, MD ; Guias, Bruno, MD ; Bettarel-Binon, Catherine, MD</creator><creatorcontrib>Carpentier, Patrick H., MD ; Poulain, Caroline, MD ; Fabry, Régine, PhD ; Chleir, Franck, MD ; Guias, Bruno, MD ; Bettarel-Binon, Catherine, MD ; Venous Working Group of the Société Française de Médecine Vasculaire</creatorcontrib><description>Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of >3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions. However, these results already document that venous symptoms can be differentiated from leg symptoms of other origins.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2007.06.044</identifier><identifier>PMID: 17980285</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cardiovascular system ; Chronic Disease ; Factor Analysis, Statistical ; Female ; Health Status Indicators ; Humans ; Likelihood Functions ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Ultrasonography, Doppler, Duplex ; Vascular Diseases - diagnosis ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Vascular wall ; Venous Insufficiency - diagnosis</subject><ispartof>Journal of vascular surgery, 2007-11, Vol.46 (5), p.991-996</ispartof><rights>The Society for Vascular Surgery</rights><rights>2007 The Society for Vascular Surgery</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-119cb099c6e23f943b24d17e91468600203d88390c9d5b1f26ffe9baad0d678e3</citedby><cites>FETCH-LOGICAL-c479t-119cb099c6e23f943b24d17e91468600203d88390c9d5b1f26ffe9baad0d678e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521407011226$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>309,310,314,776,780,785,786,3537,23911,23912,25120,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20086091$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17980285$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carpentier, Patrick H., MD</creatorcontrib><creatorcontrib>Poulain, Caroline, MD</creatorcontrib><creatorcontrib>Fabry, Régine, PhD</creatorcontrib><creatorcontrib>Chleir, Franck, MD</creatorcontrib><creatorcontrib>Guias, Bruno, MD</creatorcontrib><creatorcontrib>Bettarel-Binon, Catherine, MD</creatorcontrib><creatorcontrib>Venous Working Group of the Société Française de Médecine Vasculaire</creatorcontrib><title>Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of >3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions. However, these results already document that venous symptoms can be differentiated from leg symptoms of other origins.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Chronic Disease</subject><subject>Factor Analysis, Statistical</subject><subject>Female</subject><subject>Health Status Indicators</subject><subject>Humans</subject><subject>Likelihood Functions</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Ultrasonography, Doppler, Duplex</subject><subject>Vascular Diseases - diagnosis</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Vascular wall</subject><subject>Venous Insufficiency - diagnosis</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUGL1DAYhoMo7rj6A7xIL3pr_ZJ2kkZhYVlcFRY8uF68hDT5OpvaacZ87cD8ezPMsIIHT7k878uX52XsNYeKA5fvh2rYUyUAVAWygqZ5wlYctCplC_opW4FqeLkWvLlgL4gGAM7XrXrOLrjSLYh2vWI_r8ml0IVpU4y4Keiw3c1xS8UcC_eQ4hRcsccpLlT4QDF5TPShuH_AwsWJ5rS4OcSpiH1hM2A3U6Q5R8jFhC_Zs96OhK_O7yX7cfvp_uZLefft89eb67vSNUrPJefadaC1kyjqXjd1JxrPFWreyFYCCKh929YanPbrjvdC9j3qzloPXqoW60v27tS7S_H3gjSbbSCH42gnzIcb2TaqhlpkkJ9AlyJRwt7sUtjadDAczFGoGUwWao5CDUiThebMm3P50m3R_02cDWbg7Rmw5OzYJzu5QI9c7sqf0DxzH08cZhX7gMmQCzg59CGhm42P4b9nXP2TdmPI49jxFx6QhrikKTs23JAwYL4flz8ODypvLoSs_wC9kqhz</recordid><startdate>20071101</startdate><enddate>20071101</enddate><creator>Carpentier, Patrick H., MD</creator><creator>Poulain, Caroline, MD</creator><creator>Fabry, Régine, PhD</creator><creator>Chleir, Franck, MD</creator><creator>Guias, Bruno, MD</creator><creator>Bettarel-Binon, Catherine, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20071101</creationdate><title>Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score</title><author>Carpentier, Patrick H., MD ; Poulain, Caroline, MD ; Fabry, Régine, PhD ; Chleir, Franck, MD ; Guias, Bruno, MD ; Bettarel-Binon, Catherine, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-119cb099c6e23f943b24d17e91468600203d88390c9d5b1f26ffe9baad0d678e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Chronic Disease</topic><topic>Factor Analysis, Statistical</topic><topic>Female</topic><topic>Health Status Indicators</topic><topic>Humans</topic><topic>Likelihood Functions</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Ultrasonography, Doppler, Duplex</topic><topic>Vascular Diseases - diagnosis</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Vascular wall</topic><topic>Venous Insufficiency - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carpentier, Patrick H., MD</creatorcontrib><creatorcontrib>Poulain, Caroline, MD</creatorcontrib><creatorcontrib>Fabry, Régine, PhD</creatorcontrib><creatorcontrib>Chleir, Franck, MD</creatorcontrib><creatorcontrib>Guias, Bruno, MD</creatorcontrib><creatorcontrib>Bettarel-Binon, Catherine, MD</creatorcontrib><creatorcontrib>Venous Working Group of the Société Française de Médecine Vasculaire</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carpentier, Patrick H., MD</au><au>Poulain, Caroline, MD</au><au>Fabry, Régine, PhD</au><au>Chleir, Franck, MD</au><au>Guias, Bruno, MD</au><au>Bettarel-Binon, Catherine, MD</au><aucorp>Venous Working Group of the Société Française de Médecine Vasculaire</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2007-11-01</date><risdate>2007</risdate><volume>46</volume><issue>5</issue><spage>991</spage><epage>996</epage><pages>991-996</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of >3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions. However, these results already document that venous symptoms can be differentiated from leg symptoms of other origins.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>17980285</pmid><doi>10.1016/j.jvs.2007.06.044</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0741-5214 |
ispartof | Journal of vascular surgery, 2007-11, Vol.46 (5), p.991-996 |
issn | 0741-5214 1097-6809 |
language | eng |
recordid | cdi_proquest_miscellaneous_68473032 |
source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals |
subjects | Adult Aged Biological and medical sciences Cardiovascular system Chronic Disease Factor Analysis, Statistical Female Health Status Indicators Humans Likelihood Functions Male Medical sciences Middle Aged Pharmacology. Drug treatments Prospective Studies ROC Curve Sensitivity and Specificity Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Ultrasonography, Doppler, Duplex Vascular Diseases - diagnosis Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Vascular wall Venous Insufficiency - diagnosis |
title | Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T10%3A34%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Ascribing%20leg%20symptoms%20to%20chronic%20venous%20disorders:%20The%20construction%20of%20a%20diagnostic%20score&rft.jtitle=Journal%20of%20vascular%20surgery&rft.au=Carpentier,%20Patrick%20H.,%20MD&rft.aucorp=Venous%20Working%20Group%20of%20the%20Soci%C3%A9t%C3%A9%20Fran%C3%A7aise%20de%20M%C3%A9decine%20Vasculaire&rft.date=2007-11-01&rft.volume=46&rft.issue=5&rft.spage=991&rft.epage=996&rft.pages=991-996&rft.issn=0741-5214&rft.eissn=1097-6809&rft.coden=JVSUES&rft_id=info:doi/10.1016/j.jvs.2007.06.044&rft_dat=%3Cproquest_cross%3E68473032%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=68473032&rft_id=info:pmid/17980285&rft_els_id=1_s2_0_S0741521407011226&rfr_iscdi=true |