Skip to main content
SpringerLink
Log in

Landmarks Along the Application of Laser Energy for Cardiovascular Therapy

  • Chapter
Lasers in Cardiovascular Interventions

  • 721 Accesses

Abstract

Soon after the development of the first laser, the ruby laser, there was a flurry of studies evaluating it for medical applications. The initial use was in the fields of dermatology and ophthalmology due to the unique feature of laser wavelength to be selectively absorbed by specific tissue color. However, effects on vascular tissue soon followed. The development of flexible fiber optic cables that carry the laser over distances made it possible to deliver high energy wavelengths through catheter systems deep into the arterial system via percutaneous methods. Continuous wave laser systems (i.e., argon and Nd-Yag) were initially used but were fraught with arterial wall perforation. However, pulsed laser systems (i.e., Ho:Yag and excimer) provided higher precision cutting and became more widely accepted. The effect of shock waves in tissues generated by collapsing microbubbles were reduced by using saline to displace blood in the field and increasing the duration between pulse deliveries. The advantage of lasers in the arterial system is its ability to cut through calcific plaques and recannalize long arterial occlusions. That is especially well suited for the peripheral arterial circulation. In the coronary circulation left main lesions and thrombotic lesions are also well suited for laser therapy. This chapter describes the evolution in the use of lasers in the arterial circulation and the current comeback in their utilization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Einstein A. Zur quantentheorie de strahlung. Phys Z. 1917;18:121–8.

    CAS  Google Scholar 

  2. Schawlaow AL, Townes CI. Infrared and optical masers. Physiol Rev. 1958;112:1940.

    Article  Google Scholar 

  3. Maiman TH. Stimulated optical radiation in ruby. Nature. 1960;187:493–4.

    Article  Google Scholar 

  4. Goldman L. Biomedical aspects of the laser. New York: Springer; 1967.

    Book  Google Scholar 

  5. Koester CJ, Snitzer E, Campbell CJ, Rittler MC. Experimental laser retina coagulator. J Opt Soc Am. 1962;52:607.

    Google Scholar 

  6. McGuff PE, Bushnell D, Soroff HS, Deterling RA. Studies of the surgical application of laser light. Surg Forum. 1963;14:143–5.

    CAS  PubMed  Google Scholar 

  7. Macruz R, Martins JRM, Tupinamba A, Lopes EA, Vargas H, Pena AF, et al. Therapeutic possibilities of laser beans in atheromas. Ar Bras Cardiol (Port). 1980;34(1):9–12.

    CAS  Google Scholar 

  8. Abela GS, Conti CR, Geiser EA, Normann S, et al. The effect of laser radiation on atheromatous plaque: a preliminary report (abstr). Am J Cardiol. 1982;49:1008.

    Article  Google Scholar 

  9. Abela GS, Normann S, Cohen D, Feldman RL, Geiser EA, Conti CR. Effects of carbon dioxide, ND-Yag and argon laser radiation on coronary artheromatous plaques. Am J Cardiol. 1982;50(6):1199–205.

    Article  CAS  PubMed  Google Scholar 

  10. Abela GS, Pepine CJ. Emerging applications of laser therapy of occlusive vascular disease. Cardiovasc Rev Rep. 1985;6(3):269–78.

    Google Scholar 

  11. Fenech A, Abela GS, Crea F, Smith W, Feldman R, Conti CR. A comparative study of laser beam characteristics in blood and saline media. Am J Cardiol. 1985;55(11):1389–92.

    Article  CAS  PubMed  Google Scholar 

  12. Choy DS, Stertzer SH, Rotterdam HZ, Bruno MS. Laser coronary angioplasty: experience with 9 cadaver hearts. Am J Cardiol. 1982;50(6):1209–11.

    Article  CAS  PubMed  Google Scholar 

  13. Abela GS, Normann S, Cohen DM, Franzini D, Feldman RL, Crea F, et al. Laser recanalization of occluded atherosclerotic arteries: an in vivo and in vitro study. Circulation. 1985;71(2):403–11.

    Article  CAS  PubMed  Google Scholar 

  14. McAuley BJ, Oesterle S, Simpson JB. Advances in guidewire technology. Am J Cardiol. 1984;53(12):94C–6.

    Article  CAS  PubMed  Google Scholar 

  15. Anderson HV, Zaatari GS, Roubin GS, Leimgruber PP, Gruentzig AR. Coaxial laser energy delivery using a steerable catheter in canine coronary arteries. Am Heart J. 1987;113(1):37–48.

    Article  CAS  PubMed  Google Scholar 

  16. Bittl JA, Sanborn TA, Abela GS, Isner JM. Wire-guided excimer laser coronary angioplasty: instrument selection, lesion characterization, and operator technique. J Interv Cardiol. 1992;5:275–91.

    Article  CAS  PubMed  Google Scholar 

  17. Ishibashi F, Aziz K, Abela GS, Waxman S. Update on coronary angioscopy: review of a 20-year experience and potential application for detection of vulnerable plaque. J Interv Cardiol. 2006;19(1):1–9.

    Article  Google Scholar 

  18. Deckelbaum LI, Lau JK, Cobin HS, Clubb KS. Discrimination of normal and atherosclerotic aorta by laser induced fluorescence. Lasers Surg Med. 1987;7(4):330–5.

    Article  CAS  PubMed  Google Scholar 

  19. Kittrell C, Willet RL, de Los Santos-Pacheo C, Ratliff NB, Kramer JR, Malk EG, Feld MS. Diagnosis of fibrous arterial atherosclerosis using fluorescence. Appl Opt. 1985;24(15):2280–1.

    Google Scholar 

  20. Sartori M, Sauerbrey R, Kobodero S, Tittle FK, Roberts R, Henry P. Auto fluorescence maps of atherosclerotic human arteries-a new technique in medical imaging. IEEE J Quantum Electon QE. 1987;10:1794–7.

    Article  Google Scholar 

  21. Leon MB, Lu DY, Prevosti LG, Macy W, Smith PD, Granovsky M, et al. Human arterial surface fluorescence: atherosclerotic plaque identification and effects of laser thrombus ablation. J Am Coll Cardiol. 1988;12(1):94–102.

    Article  CAS  PubMed  Google Scholar 

  22. Friedl SE, Mathews ED, Miyamoto A, Abela GS. Intravascular ultrasound can be used to evaluate pulsed Ho:YAG laser ablation of arterial tissue. Lasers Surg Med. 1995;16(2):156–63.

    Article  CAS  PubMed  Google Scholar 

  23. Abela GS, Fenech A, Crea F, Conti CR. “Hot tip”: another method of laser vascular recanalization. Lasers Surg Med. 1985;5(3):327–35.

    Article  CAS  PubMed  Google Scholar 

  24. Ryan TJ, Sanborn TA, Cumberland DC, Faxon DP, Haudenschild CC. Laser thermal angioplasty: from the experimental model to early human experience. Trans Am Clin Climatol Assoc. 1987;98:36–42.

    PubMed Central  CAS  PubMed  Google Scholar 

  25. Abela GS, et al. Catheter systems for laser angioplasty in lasers. In: Abela GS, editor. Cardiovascular medicine and surgery: fundamentals and Techniques. Norwell: Kluwer Publishers; 1990. Published with permission.

    Chapter  Google Scholar 

  26. Hoffman RG, Abela GS, Friedl SE, Hojjatie B, Barbeau GR. Dosimetry of plaque ablation using thermal-optical probe system. Proc SPIE Optical Fibers Med. 1989;IV(1067):120–6.

    Google Scholar 

  27. Abela GS, Seeger JM, Barbieri E, Franzini D, Fenech A, Pepine CJ, Conti CR. Laser angioplasty with angioscopic guidance in humans. J Am Coll Cardiol. 1986;8(1):182–94.

    Article  Google Scholar 

  28. Barbeau GR, Abela GS, Seeger JM, Friedl SE, Tomaru T, Giacomino P. Temperature monitoring during peripheral thermo-optical laser recanalization in humans. Clin Cardiol. 1990;13:690–7.

    Article  CAS  PubMed  Google Scholar 

  29. Verdaasdonk RM, Borst C. Ray tracing of optically modified fiber tips. 1: spherical probes. Appl Opt. 1991;30(16):2159–71.

    Article  CAS  PubMed  Google Scholar 

  30. Jenkins RD, Spears JR. Laser balloon angioplasty. A new approach to abrupt coronary occlusion and chronic restenosis. Circulation. 1990;81(3 Suppl):IV101–8.

    CAS  PubMed  Google Scholar 

  31. Spokojny AM, Serur JR, Skillman J, Spears JR. Uptake of hematoporphyrin derivative by atheromatous plaques: studies in human in vitro and rabbit in vivo. J Am Coll Cardiol. 1986;8(6):1387–92.

    Article  CAS  PubMed  Google Scholar 

  32. Deckelbaum LI, Isner JM, Donaldson RF, Laliberte SM, Clarke RH, Salem DN. Use of pulsed energy delivery to minimize tissue injury resulting from carbon dioxide laser irradiation of cardiovascular tissues. J Am Coll Cardiol. 1986;7(4):898–908.

    Article  CAS  PubMed  Google Scholar 

  33. Bowker TJ, Cross FW, Rumsby P, Gower MC, Rickards AF, Bown SG. Excimer laser angioplasty: quantitative comparison in vitro of three ultraviolet wavelengths on tissue ablation and haemolysis. Lasers Med Sci. 1986;1(2):91–100.

    Article  Google Scholar 

  34. Isner JM, Donaldson RF, Deckelbaum LI, Clarke RH, Laliberte SM, Ucci AA, et al. The excimer laser: gross, light microscopic and ul-trastructural analysis of potential advantages for use in laser therapy of cardiovascular disease. J Am Coll Cardiol. 1985;6(5):1102–9.

    Article  CAS  PubMed  Google Scholar 

  35. Grundfest WS, Litvack F, Forrester JS, Goldenberg T, Swan HJ, Morgenstern L, et al. Laser ablation of human atherosclerotic plaque without adjacent tissue injury. J Am Coll Cardiol. 1985;5(4):929–33.

    Article  CAS  PubMed  Google Scholar 

  36. Goldenberg, T. Patent # WO1986003598A1, Dec 5, 1985 Jun 19, 1986. Delivery system for high-energy pulsed ultraviolet laser light. 1986.

    Google Scholar 

  37. Tomaru T, Geschwind HJ, Boussignac G, Lange F, Tahk SJ. Characteristics of shock waves induced by pulsed lasers and their effects on arterial tissue: comparison of excimer, pulse dye, and holmium YAG lasers. Am Heart J. 1992;123(4 Pt 1):896–904.

    Article  CAS  PubMed  Google Scholar 

  38. Van Leeuwen TG, Van Erven L, Meertens JH, Motamedi M, Post MJ, Borst C. Origin of arterial wall dissections induced by pulsed excimer and mid-infrared laser ablation in the pig. J Am Coll Cardiol. 1992;19:1610–8.

    Article  PubMed  Google Scholar 

  39. Isner JM, Rosenfeld K, White CJ, Ramee S, Kearney M, Pieczek A, Langevin E, Razvi S. In vitro assessment of vascular pathology resulting from laser irradiation. Circulation. 1992;85:2185–96.

    Article  CAS  PubMed  Google Scholar 

  40. Gijsbers GHM, Sprangers RLH, Keijzer M, de Bakker JMT, van Leeuwen TG, Verdaasdonk RM, Borst C, van Gemert MJC. Some laser-tissue interactions in 308 mm excimer laser coronary angioplasty. J Interv Cardiol. 1990;3:231–41.

    Article  Google Scholar 

  41. Abela GS. Abrupt closure after pulsed laser angioplasty: spasm or a “Mille-Feuilles” effect? J Interv Cardiol. 1992;5(4):259–62.

    Article  Google Scholar 

  42. Tcheng JE. Saline infusion in excimer laser coronary angioplasty. Semin Interv Cardiol. 1996;1(2):135–41.

    CAS  PubMed  Google Scholar 

  43. Topaz O, Minisi AJ, Morris C, Mohanty PK, Carr Jr ME. Photoacoustic fibrinolysis: pulsed-wave, mid-infrared laser-clot interaction. J Thromb Thrombolysis. 1996;3(3):209–14.

    Article  PubMed  Google Scholar 

  44. Topaz O, Shah R, Mohanty PK, McQueen RA, Janin Y, Bernardo NL. Application of excimer laser angioplasty in acute myocardial infarction. Lasers Surg Med. 2001;29(2):185–92.

    Article  CAS  PubMed  Google Scholar 

  45. Topaz O, Ebersole D, Das T, Alderman EL, Madyoon H, Vora K, et al. Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicenter trial). Am J Cardiol. 2004;93(6):694–701.

    Article  PubMed  Google Scholar 

  46. Cumberland DC, Sanborn TA, Tayler DI, et al. Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions. Lancet. 1986;1(8496):1457–9.

    Article  CAS  PubMed  Google Scholar 

  47. Sanborn TA, Cumberland DC, Greenfield AJ, Welsh CL, Guben JK. Percutaneous laser thermal angioplasty: initial results and 1-year follow-up in 129 femoropopliteal lesions. Radiology. 1988;168(1):121–5.

    Article  CAS  PubMed  Google Scholar 

  48. Walker C, Abben R, Chaisson G, Ladd W, Kowalski J, Pharo W, et al. Glide wire and laser in angioplasty of the superficial femoral artery initial outcomes and complications in 222 patients. J Am Coll Cardiol. 1992;19(Suppl A):314a

    Google Scholar 

  49. Barbeau GR, Seeger JM, Kaelin LD, Friedl S, Jablonski S, Abela GS. Peripheral artery recanalization in humans using balloon and laser angioplasty. Clin Cardiol. 1996;19(3):232–8.

    Article  CAS  PubMed  Google Scholar 

  50. Laird JR. Peripheral excimer laser angioplasty (PELA) trial results. Presented at TCT annual meeting, Sept 2002, Washington, DC.

    Google Scholar 

  51. Laird JR, Zeller T, Gray BH, Scheinert D, Vranic M, Reiser C, Biamino G, LACI Investigators, et al. Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial. J Endovasc Ther. 2006;13(1):1–11.

    Article  PubMed  Google Scholar 

  52. Litvack F, Eigler NL, Margolis JR, Grundfest WS, Rothbaum D, Linnemeier T, et al. Percutaneous excimer laser coronary angioplasty. Am J Cardiol. 1990;66(15):1027–32.

    Article  CAS  PubMed  Google Scholar 

  53. Karsch KR, Haase KK, Voelker W, Baumbach A, Mauser M, Seipel L. Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris. Acute results and incidence of restenosis during 6-month follow-up. Circulation. 1990;81(6):1849–59.

    Article  CAS  PubMed  Google Scholar 

  54. Sanborn TA, Bittl JA, Hershman RA, Siegel RM. Percutaneous coronary excimer laser-assisted angioplasty: initial multicenter experience in 141 patients. J Am Coll Cardiol. 1991;17(6 Suppl B):169B–73.

    Article  CAS  PubMed  Google Scholar 

  55. Stone GW, de Marchena E, Dageforde D, Foschi A, Muhlestein JB, McIvor M, et al. Prospective, randomized, multicenter comparison of laser-facilitated balloon angioplasty versus stand-alone balloon angioplasty in patients with obstructive coronary artery disease. The Laser Angioplasty Versus Angioplasty (LAVA) Trial Investigators. J Am Coll Cardiol. 1997;30(7):1714–21.

    Article  CAS  PubMed  Google Scholar 

  56. Appelman YE, Piek JJ, Strikwerda S, Tijssen JG, de Feyter PJ, David GK, et al. Randomized trial of excimer laser angioplasty versus balloon angioplasty for treatment of obstructive coronary artery disease. Lancet. 1996;347(8994):79–84.

    Article  CAS  PubMed  Google Scholar 

  57. Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, et al. Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer laser, rotational atherectomy and balloon angioplasty comparison (ERBAC) Study. Circulation. 1997;96(1):91–8.

    Article  CAS  PubMed  Google Scholar 

  58. Latib A, Takagi K, Chizzola G, Tobis J, Ambrosini V, Niccoli G, et al. Excimer Laser LEsion modification to expand non-dilatable stents: the ELLEMENT registry. Cardiovasc Revasc Med. 2014;15(1):8–12.

    Article  PubMed  Google Scholar 

  59. Piquet P, Bournot P, Caminat JF, Pellissier C, Mercier C. Excimer laser irradiation of non-calcified an calcified human atheroma (248 and 308 nm wavelengths). Lasers Med Sci. 1992;7(1–4):393–9.

    Article  Google Scholar 

  60. Vineberg AM, Walker J. The surgical treatment of coronary artery disease by internal mammary artery implantation: report of 140 cases followed up to thirteen year. Dis Chest. 1964;45:190–206.

    Article  CAS  PubMed  Google Scholar 

  61. Sen PK, Udwadia TE, Kinare SG, Parulkar G. Transmyocardial acupuncture: a new approach to myocardial revascularization. J Thorac Cardiovasc Surg. 1965;50:181–9.

    CAS  PubMed  Google Scholar 

  62. Mirhoseini M, Cayton MM. Revascularization of the heart by laser. J Microsurg. 1981;2(4):253–60.

    Article  CAS  PubMed  Google Scholar 

  63. Mirhoseini M, Shelgikar S, Cayton MM. New concepts in revascularization of the myocardium. Ann Thorac Surg. 1988;45(4):415–20.

    Article  CAS  PubMed  Google Scholar 

  64. Leon MB, Kornowski R, Downey WE, Weisz G, Baim DS, Bonow RO, et al. A blinded, randomized, placebo-controlled trial of percutaneous laser myocardial revascularization to improve angina symptoms in patients with severe coronary disease. J Am Coll Cardiol. 2005;46(10):1812–9.

    Article  PubMed  Google Scholar 

  65. Levy T, Walker S, Paul V. Initial experience in the extraction of chronically implanted pacemaker leads using the Excimer laser sheath. Heart. 1999;82(1):101–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  66. Kennergren C. Excimer laser assisted extraction of permanent pacemaker and ICD leads: present experiences of a European Multi-Centre Study. Eur J Cardiothorac Surg. 1999;15(6):856–60.

    Article  CAS  PubMed  Google Scholar 

  67. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Reiser C. Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol. 2002;25(5):804–8.

    Article  PubMed  Google Scholar 

  68. Apfelberg DB, Smith T, Maser MR, Lash H, White DN. Study of three laser systems for treatment of superficial varicosities of the lower extremity. Lasers Surg Med. 1987;7(3):219–23.

    Article  CAS  PubMed  Google Scholar 

  69. Zelt DT, LaMuraglia GM, L’Italien GJ, Megerman J, Kung RT, Stewart RB, Abbott WM. Arterial laser welding with a 1.9 micrometer Raman-shifted laser. J Vasc Surg. 1992;15(6):1025–31.

    Article  CAS  PubMed  Google Scholar 

  70. White RA, Abergel RP, Lyons R, Klein SR, Kopchok G, Dwyer RM, Uitto J. Biological effects of laser welding on vascular healing. Lasers Surg Med. 1986;6(2):137–41.

    Article  CAS  PubMed  Google Scholar 

  71. Kimura T, Takatsuki S, Miyoshi S, Fukumoto K, Takahashi M, Ogawa E, et al. Nonthermal cardiac catheter ablation using photodynamic therapy. Circ Arrhythm Electrophysiol. 2013;6(5):1025–31.

    Article  CAS  PubMed  Google Scholar 

  72. Curtis AB, Abela GS, Griffin J, Hill JA, Normann SJ. Transvascular Argon laser ablation of atrioventricular conduction in dogs: feasibility and morphologic results. Pace. 1989;12(2):347–57.

    Article  CAS  PubMed  Google Scholar 

  73. Curtis AB, Barbeau GR, Friedl SE, Kunz WF, Mansour M, Abela GS. Modification of AV conduction using a percutaneous combined laser-electrode catheter. Pace. 1994;17(3 Pt 1):337–48.

    Article  CAS  PubMed  Google Scholar 

  74. Wagshall A, Abela GS, Maheshwari A, Gupta A, Bowden R, Huang S. A novel catheter design for laser photocoagulation of the myocardium to ablate ventricular tachycardia. J Interv Card Electrophysiol. 2002;7(1):13–22.

    Article  PubMed  Google Scholar 

  75. Litvack F, Grundfest WS, Forrester JS, Fishbein MC, Swan HJ, Corday E, Rider DM, McDermid IS, Pacala TJ, Laudenslager JB. Effects of hematoporphyrin derivative and photodynamic therapy on atherosclerotic rabbits. Am J Cardiol. 1985;56(10):667–71.

    Article  CAS  PubMed  Google Scholar 

  76. Waksman R, McEwan P, Moore T, Pakala R, Kolodgie F, Hellinga D, et al. PhotoPoint photodynamic therapy promotes stabilization of atherosclerotic plaques and inhibits plaque progression. J Am Coll Cardiol. 2008;52(12):1024–32.

    Article  CAS  PubMed  Google Scholar 

  77. Abela GS, Conti CR. The use of the laser in the treatment of coronary and peripheral arterial obstruction. In: Schlant RC, Alexander RW, O’Rourke RA, Roberts R, Sonnenblick EH, editors. Hurst’s the heart. 8th ed. New York: McGraw-Hill Publisher; 1994.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Michigan State University (CHM), Borgess Medical Center, East Lansing, MI, USA

    Jagadeesh Kumar Kalavakunta MD

  2. Division of Cardiology, Department of Medicine, Michigan State University (CHM), East Lansing, MI, USA

    Mohammad Anas Hajjar MD & Prem Srinivas Subramaniyam MD

  3. Division of Cardiology, Department of Medicine, B208 Clinical Center, Michigan State University (CHM), East Lansing, MI, USA

    George S. Abela MD, MSc, MBA, FACC, FAHA, FNLA

  4. Division of Pathology, Department of Physiology, Michigan State University, East Lansing, MI, 48824, USA

    George S. Abela MD, MSc, MBA, FACC, FAHA, FNLA

Authors
  1. Jagadeesh Kumar Kalavakunta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammad Anas Hajjar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prem Srinivas Subramaniyam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George S. Abela MD, MSc, MBA, FACC, FAHA, FNLA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George S. Abela MD, MSc, MBA, FACC, FAHA, FNLA .

Editor information

Editors and Affiliations

  1. Division of Cardiology, Charles George VA Medical Center, Asheville, North Carolina, USA

    On Topaz

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Kalavakunta, J.K., Hajjar, M.A., Subramaniyam, P.S., Abela, G.S. (2015). Landmarks Along the Application of Laser Energy for Cardiovascular Therapy. In: Topaz, O. (eds) Lasers in Cardiovascular Interventions. Springer, London. https://doi.org/10.1007/978-1-4471-5220-0_27

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5220-0_27

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5219-4

  • Online ISBN: 978-1-4471-5220-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation