metricas
covid
Buscar en
Cirugía Española (English Edition)
Toda la web
Inicio Cirugía Española (English Edition) General surgeons and varicose vein surgery
Journal Information
Vol. 85. Issue 4.
Pages 205-213 (April 2009)
Share
Share
Download PDF
More article options
Vol. 85. Issue 4.
Pages 205-213 (April 2009)
Special article
Full text access
General surgeons and varicose vein surgery
Los cirujanos generales frente a la cirugía de las varices
Visits
2165
Germán Morales-Cuelnca
Corresponding author
germanmorales@ono.com

Author for correspondence.
, Alfredo Moreno-Egea, Jose Luis Aguayo-Albasini
Servicio de Cirugía General, Hospital J.M. Morales Meseguer, Murcia, Spain
This item has received
Article information
Abstract

Chronic venous insufficiency is a highly prevalent condition, with significant health and economic repercussions. Although important therapeutic developments have been introduced in recent years, the majority are dealt with by general surgeons in national health hospitals. These surgeons do not have the required and continuous training, and continue to perform classic surgery techniques. Also, their presence at scientific, organisational meetings, and training is almost nil. We present an update on developments in phlebology, and tapping into the preliminary results of a national survey, we reflect on the current status of phlebology and beyond for those general surgeons who should have a role in this field.

Keywords:
Phlebology
General surgeon
Varicose veins
Treatment
Resumen

La insuficiencia venosa crónica es una enfermedad muy prevalente, de una gran relevancia sanitaria y económica, y en la que en los últimos años se están produciendo importantes novedades terapéuticas. Aunque en la mayoría de los hospitales públicos su asistencia recae sobre los cirujanos generales, éstos no disponen de una formación continuada adecuada y continúan realizando habitualmente una cirugía clásica. Además, su presencia en el ámbito científico, organizativo y formativo es casi nula. Presentamos una actualización sobre las novedades en flebología y, aprovechando los resultados preliminares de una encuesta nacional, reflexionamos sobre la situación actual de la flebología y el futuro que los cirujanos generales tienen en este campo.

Palabras clave:
Flebología
Cirujanos generales
Varices
Tratamiento
Full text is only aviable in PDF
References
[1.]
J.M. Gutiérrez-Julián.
Angiología y cirugía vascular: una especialidad polivalente.
Angiología, 59 (2007), pp. 351-357
[2.]
C.J. Evans, F.G. Fowkes, C.V. Ruckley, A.J. Lee.
Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study.
J Epidemiol Community Health, 53 (1999), pp. 149-153
[3.]
R. Gesto-Castromil, J.J. García, Grupo DETECT-IVC.
Encuesta epidemiológica realizada en España sobre la prevalencia asistencial de la insuficiencia venosa crónica en atención primaria. Estudio DETECT-IVC.
Angiología, 53 (2001), pp. 249-260
[4.]
L.J. Alvarez Fernández, F. Lozano, J. Marinello Roura, J.A. Masegosa Medina.
Encuesta epidemiológica sobre la insuficiencia venosa crónica en España: estudio DETECT-IVC 2006.
Angiología, 60 (2008), pp. 27-36
[5.]
M.J. Callam, D.R. Harper, J.J. Dale, C.V. Ruckley.
Chronic ulcer of the leg: clinical history.
Br Med J (Clin Res Ed), 294 (1987), pp. 1389-1391
[6.]
M. McGuckin, R. Waterman, J. Brooks, et al.
Validation of venous leg ulcer guidelines in the United States and United Kindom.
Am J Surg, 183 (2002), pp. 132-137
[7.]
M.A. Palomino Medina, P.J. Tárraga López, A.V. Robayna Elvira, D. García Olmo, J.A. Rodríguez Montes, A. Celada Rodríguez, et al.
Impacto socioeconómico de la insuficiencia venosa crónica en una Zona Básica de Salud de Atención Primaria.
Rev Esp Econ Salud, 3 (2004), pp. 336-344
[8.]
M.A. Palomino-Medina, P.J. Tárraga-López, D. García-Olmo, J.A. Rodríguez-Montes, A.V. Robayna-Elvira, M. López Cara.
Factores epidemiológicos de la insuficiencia venosa crónica en una zona básica de salud.
Angiología, 56 (2004), pp. 445-457
[9.]
Carbonell-Tatay A, Casp Vanaclocha V, Landete Molina FJ, Manzanares Ferrer C, Garay Burdeos M, Llopis Candela A. Varices en miembros inferiores intervenidas en un Hospital Comarcal. Técnica quirúrgica de elección. Arch Cir Gen Dig. 2004. Available from: http://www.cirugest.com/revista/2004/05-17/2004-05-17.htm
[10.]
R.B. Galland, P.J. Whatling, T.J. Crook, T.R. Magee.
Regional variation in varicose vein operations in England 1989–1996.
Ann Roy Coll Surg Eng, 82 (2000), pp. 275-279
[11.]
J.J. Smith, A.M. Garrat, M. Guest, R.M. Greenhalgh, A.H. Davies.
Evaluating and improving healthrelated quality of life in patients with varicose veins.
J Vasc Surg, 30 (1999), pp. 710-719
[12.]
J.A. Heit, M.D. Silverstein, D.N. Mohr, T.M. Petterson, W.M. O’Fallon, L.J. Melton III.
Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study.
Arch Intern Med, 160 (2000), pp. 809-815
[13.]
M. Yapanis, A.W. Bradbury.
Varicose vein surgery.
Update in vascular surgery, pp. 125-131
[15.]
H.G. Beebe, J.J. Bergan, D. Bergqvist, et al.
Classification and grading of chronic venous disease in the lower limbs. A consensus statement.
Eur J Vasc Endovasc Surg, 12 (1996), pp. 487-491
[16.]
J.M. Porter, G.L. Moneta, un comité de consenso internacional en enfermedad venosa crónica.
Reporting standards in venous disease: an update.
J Vasc Surg, 21 (1995), pp. 634-645
[17.]
B. Eklöf, R.B. Rutherford, J.J. Bergan, P.H. Carpentier, P. Gloviczki, R.L. Kistner, for the American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification, et al.
Revision of the CEAP classification for chronic venous disorders: consensus statement.
J Vasc Surg, 40 (2004), pp. 1248-1252
[18.]
S. Nitecki, A. Kantarovsky, I. Portnoy, A. Bass.
The contemporary treatment of varicose veins (strangle, strip, grill or poison).
Isr Med Assoc J, 8 (2006), pp. 411-415
[19.]
M.P. Goldman.
Conservative therapy for venous disease.
The fundamentals of phebology. Venous diseases for clinicians, pp. 67-74
[20.]
R.A. Weiss.
Compresion.
Vein diagnosis & treatment: a comprehensive approach, pp. 131-143
[21.]
M.S. Gohel, J.R. Barwell, M. Taylor, T. Chant, C. Foy, J.J. Earnshaw, et al.
Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial.
[22.]
B.R. Hartmann, B. Drews, T. Kayser.
Physical therapy improves venous hemodynamics in cases of primary varicosity: results of a controlled study.
Vasc Surg, 48 (1997), pp. 157-162
[23.]
J.J. Bergan.
Surgical procedures for varicose veins axial stripping and stab avulsion.
Atlas of venous surgery, pp. 61
[24.]
W.L. Keller.
A new method of extirpating the internal saphenous and similar veins in varicose conditions: a preliminary report.
NY Med J, 82 (1905), pp. 385-386
[25.]
C.H. Mayo.
Treatment of varicose veins.
Surg Gynecol Obstet, 2 (1906), pp. 385-388
[26.]
L. Jones, B.D. Braithwaite, D. Selwyn, S. Cooke, J.J. Earnshaw.
Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein.
Eur J Vasc Endovasc Surg, 12 (1996), pp. 442-445
[27.]
S. Dwerryhouse, B. Davies, K. Harradine, J.J. Earnshaw.
Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-years results of a randomized trial.
J Vasc Surg, 29 (1999), pp. 589-592
[28.]
A.C. Seidel, F. Miranda Jr., Y. Juliano, N.F. Novo, J.H. Dos Santos, D.F. de Souza.
Prevalence of varicose veins and venous anatomy in patients without truncal saphenous relux.
Eur J Vasc Endovasc Surg, 28 (2004), pp. 387-390
[29.]
N.D. Pizano, J. Duque.
¿Por qué se ha hecho safenectomía? Resultados a largo plazo de la cayadectomía.
Rev Colomb Cir Vasc, 7 (2007), pp. 12-35
[30.]
S. Ricci, A. Cavezzi.
Echo-anatomy of long saphenous vein in the knee region: proposal for a clasfication in five anatomical patterns.
Phlebology, 16 (2002), pp. 111-116
[31.]
K.A. Myers, S.R. Wood, V. Lee, P. Koh.
Variations of connections to the saphenous system in limbs with primary varicose veins: a study in 1481 limbs by duplex ultrasound scanning.
J Phlebol, 2 (2002), pp. 11-17
[32.]
R.B. Rutherford, J.D. Sawyer, D.N. Jones.
The fate of residual saphenous vein after partial removal or ligation.
J Vasc Surg, 12 (1990), pp. 422-426
[33.]
L. Fligelstone, G. Carolan, N. Pugh, A. Shandall, I. Lane.
An assessment of the long saphenous vein for potential use as a vascular conduit after varicose vein surgery.
J Vasc Surg, 18 (1993), pp. 836-840
[34.]
L.J. Fligelstone, R.A. Salaman, T.O. Oshodi, I. Wright, N. Pugh, A.A. Shandall, et al.
Flush saphenofemoral ligation and multiple stab phlebectomy preserve a useful greater saphenous vein four years after surgery.
J Vasc Surg, 24 (1996), pp. 905-906
[35.]
S.J. Cox, L.M. Wellwood, A. Martin.
Saphenous nerve injury caused by stripping of the long saphenous vein.
Br Med J, 1 (1974), pp. 415-417
[36.]
V. Dayan, S. Cubas, G. Carriquiry.
Anatomía del nervio safeno interno en su segmento infrapatelar.
Rev Arg Cir Cardiovasc, 4 (2006), pp. 28-34
[37.]
S.R. Munn, J.B. Morton, W.A.A.G. Macbeth, et al.
To strip or not to strip the long saphenous vein? A varicose veins trial.
Br J Surg, 68 (1981), pp. 426-428
[38.]
J.J. Wood, H. Chant, M. Laugharne, T. Chant, D.C. Mitchel.
A prospective study of cutaneous nerve injury following long saphenous vein surgery.
Eur J Vasc Endovasc Surg, 30 (2005), pp. 654-658
[39.]
K. Koyano, S. Sakaguchi.
Selective stripping operation based on Doppler ultrasonic findings for primary varicose veins of the lower extremities.
Surgery, 103 (1998), pp. 615-619
[40.]
J. Herman, M. Lovecek, I. Svach, M. Duda.
Limited versus total stripping of vena saphena magna.
Bratisl Lek Listy, 103 (2002), pp. 434-436
[41.]
L. Irace, A. Siani, A. Laurito, F. Cappello, M. Brunetti, M. Tozzi.
Indication for short stripping of the great saphenous vein. Results and indications.
Minerva Cardioangiol, 49 (2001), pp. 383-387
[42.]
J. van der Stricht.
Saphenectomy by invagination by thread.
Presse Med, 71 (1963), pp. 1081-1082
[43.]
B.B. Hill, R.M. Faruqi, F.R. Arko, C.K. Zarins, T.J. Fogarty.
“Over-thewire” inversion saphenectomy: a simple, minimally invasive vein harvesting technique for arterial bypass.
J Endovasc Ther, 12 (2005), pp. 394-400
[44.]
H. Lacroix, A. Nevelsteen, R. Suy.
Invaginating versus classic stripping of the long saphenous vein. A randomized prospective study.
Acta Chir Belg, 99 (1999), pp. 22-25
[45.]
M.T. Durkin, E.P. Turton, D.J. Scott, D.C. Berridge.
A prospective randomised trial of PIN versus conventional stripping in varicose vein surgery.
Ann R Coll Surg Engl, 81 (1999), pp. 171-174
[46.]
C. Franceschi.
La cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA).
J Mal Vasc, 17 (1992), pp. 291-300
[47.]
M. Capelli, R. Molino Lova, S. Ermini, A. Turchi, G. Bono, C. Franceschi.
Comparaison entre cure CHIVA et stripping dans le traitement des veines variqueuses des membres inférieurs: suivi de trois ans.
J Mal Vasc, 21 (1996), pp. 40-46
[48.]
J.M. Fichelle, P. Carbone, C. Franceschi.
Résultats de la cure hémodynamique de l’insuffisance veineuse en ambulatoire (CHIVA).
J Mal Vasc, 17 (1992), pp. 224-228
[49.]
J. Maeso, J. Juan, J.M. Escribano, N. Allegue, A. Di Matteo, E. González, et al.
Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the coger extremities.
Ann Vasc Surg, 15 (2001), pp. 661-665
[50.]
E. Iborra-Ortega, E. Barjau-Urrea, R. Vila-Coll, H. Ballón-Carazas, M.A. Cairols-Castellote.
Estudio comparativo de dos técnicas quirúrgicas en el tratamiento de las varices de las extremidades inferiores: resultados tras cinco años de seguimiento.
Angiología, 58 (2006), pp. 459-468
[51.]
S. Dwerryhouse, B. Davies, K. Harradine, J.J. Earnshaw.
Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five year of a randomized trial.
J Vasc Surg, 29 (1999), pp. 589-592
[52.]
N.S. Sadick.
Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure.
Dermatol Clin, 23 (2005), pp. 443-455
[53.]
M.P. Goldman, M. Mauricio, I. Rao.
Intravascular 1320-nm laser closure of GSV: a 6–12 month follow-up study.
Dermatol Surg., 30 (2004), pp. 1380-1385
[54.]
R.A. Weiss, M. Weiss.
Controlled radiofrequency endovenous occlusion using a unique radiofrequency catéter Ander duplex guidance to eliminate saphenous reflux. A 2-year follow-up.
Dermatol Surg, 28 (2002), pp. 38-42
[55.]
N. Morrison.
Saphenous ablation: what are the choices, laser or RF energy.
Semin Vasc Surg, 18 (2005), pp. 15-18
[56.]
A.M. Dietzek.
Endovenous radiofrequency ablation for the treatment of varicose veins.
Vascular, 15 (2007), pp. 255-261
[57.]
R.F. Merchant, O. Pichot, K.A. Myers.
Four year follow-up on endovascular radiofrecuency obliteration of great saphenous reflux.
Surg Dermatol, 31 (2005), pp. 129-134
[58.]
F. Lurie, D. Creton, B. Eklof, et al.
Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study).
J Vasc Surg, 38 (2003), pp. 207-214
[59.]
T. Rautio, A. Ohinmaa, J. Peršlš, P. Ohtonen, T. Heikkinen, H. Wiik, et al.
Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of costs.
J Vasc Surg, 35 (2002), pp. 958-965
[60.]
I.T. Hobbs.
Surgery and sclerotherapy in the treatment of varicose veins. A randomized trial.
Arch Surg, 109 (1974), pp. 793-796
[61.]
E.I. Orbach.
Sclerotheraphy of varicose veins: utilization o fan intravenous air-block.
Am J Surg, 66 (1944), pp. 362-366
[62.]
W.G. Fegan.
Injection with compression as a treatment for varicose veins.
Proc R Soc Med, 58 (1965), pp. 874-876
[63.]
J.R. Cabrerra Garrido.
Elargissement des limits de la sclérothérapie: nouveaux produits sclérosants.
Phlébologie, 50 (1997), pp. 181-188
[64.]
I.I. Guex.
Foam sclerotherapy: an overview of use for primary venous insuficiency.
Semen Vasc Surg, 18 (2005), pp. 25-29
[65.]
L. Tessari.
Nouvelle technique d’obtention de la scléromousse.
Phlébologie, 53 (2000), pp. 129-133
[66.]
J. Bergan, L. Pascarella, L. Mekenas.
Venous disorders: treatment with sclerosant foam.
J Cardiovasc Surg (Torino), 47 (2006), pp. 9-18
[67.]
G. Belcaro, M.R. Cesarone, A. DiRenzo, et al.
Foamsclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 20-year, prospective, randomized, controlled trial (VEDICO trial).
Angiology, 54 (2003), pp. 307-315
[68.]
J.M. Barrett, B. Allen, A. Ockelford, et al.
Microfoam ultrasoundguided sclerotheapy of varicose veins in 100 legs.
Dermatol Surg, 30 (2004), pp. 6-12
[69.]
C. Hamel-Desnos, P. Desnos, J.C. Wollmann, et al.
Evaluation of the efficacy of polidocanol in the form of foam compared with liquid foam in sclerotherapy of the greater saphenous vein: initial results.
Dermatol Surg, 29 (2003), pp. 1170-1175
[70.]
F.X. Breu, S. Guggenbichler.
European Consensus Meeting on Foam Sclerotherapy, April 4–6, 2003 Tegernsee, Germany.
Dermatol Surg, 30 (2004), pp. 709-717
[71.]
M.V. Forlee, M. Grouden, D.J. Moore, G. Shanik.
Stroke after varicose vein foam injection sclerotherapy.
J Vasc Surg, 43 (2006), pp. 162-164
[72.]
S. Ricci.
Ambulatory phlebectomy. Principles and evolution of the method.
Dermatol Surg, 24 (1998), pp. 459-464
[73.]
G. Chavez-Reyes, S.J. Chirinos-Caraza.
Safenectomía ambulatoria segmentaria.
Acta Med Per, 23 (2006), pp. 56-58
[74.]
N.S. Sadick, H. Schanzer.
Combined high ligation and stab evulsion for varicose veins in an outpatient setting.
Dermatol Surg, 24 (1998), pp. 475-479
[75.]
M.P. Goldman, S. Amira.
Closure of the greater saphenous vein with endoluminal radiofrequency termal heating of the vein wall in combination with ambulatory phlebectomy: 50 patients with more than 6-month follow-up.
Dermatol Surg, 28 (2002), pp. 29-31
[76.]
N.S. Sadick, S. Wasser.
Cobined endovascular laser with ambulatory phlebectomy for the treatment of superficial venous incompetente: a 2-year perspectiva.
J Cosmet Laser Ther, 6 (2004), pp. 44-49
[77.]
N.S. Sadick.
Controlled radiofrecuency mediated endovenous shrinkage and occlusion of the greater saphenous vein.
Cosmetic Dermatology, 18 (2001), pp. 14-16
[78.]
M. Doblas, R. Gutiérrez Romero, J. Fontcuberta, A. Orgaz, P. López Verte.
Ligadura subfascial endoscópica de venas perforantes.
Anales de Cirugía Cardiaca y Vascular, 11 (2005), pp. 38-44
[79.]
P. Gloviczki.
Subfascial endoscopic perforator vein surgery: indications and results.
Vasc Med, 4 (1999), pp. 173-180
[80.]
J.M. Rhodes, P. Gloviczki.
Endoscopic perforating vein surgery.
Surg Clin North Am, 79 (1999), pp. 667-681
[81.]
R.R. Linton.
The comminicating veins of the lower leg and the operative technic or their ligation.
Ann Surg, 107 (1938), pp. 582-593
[82.]
M. Szostek, M. Skorski, S. Zajac, A. Kosicki, W. Zlotorowicz, M. Fraczek.
Recurrences after surgical treatment of patients with post-thrombotic syndrome of the lower extremities.
Eur J Vasc Surg, 2 (1988), pp. 191-192
[83.]
U. Hauer.
The endoscopic subfascial division of the perforating veins-preliminary report (in German).
VASA, 14 (1985), pp. 59-61
[84.]
E.G.J.M. Pierik, C.H.A. Wittens, H. van Urk.
Subfascial endoscopic ligation in the treament of incompetent perforating veins.
Eur J Vasc Endovasc Surg, 9 (1995), pp. 38-41
[85.]
I. Cañizares, A. Juan, F. Luque, R. Benvenuto, I. Ortiz, A. Uceda.
Insuficiencia de venas perforantes en miembros inferiores. Ligadura subfascial endoscópica.
Cir Esp, 71 (2002), pp. 63-67
[86.]
J.J. Bergan, J. Murray, K. Greason.
Subfascial endoscopic perforator vein surgery. A preliminary report.
Ann Vasc Surg, 10 (1996), pp. 211-219
[87.]
P. Gloviczki, R.A. Cambria, Y.E. Rhee, L.U. Canton, M.A. McKusick.
Surgical technique and preliminary results with endoscopic subfascial division of perforating veins.
J Vasc Surg, 23 (1996), pp. 517-523
[88.]
M.D. Iafrati, G.J. Pare, T.F. O’Donnell, J. Estes.
Is the nihilistic approach to surgical reduction of superficial and perforator vein incompetence for venous ulcer justified?.
J Vasc Surg, 36 (2002), pp. 1167-1174
[89.]
F. Roka, M. Binder, K. Bohler-Sommeregger.
Mid-term recurrence rate of incompetent perforating veins after combined superficial vein surgery and subfascial endoscopic perforating vein surgery.
J Vasc Surg, 44 (2006), pp. 359-363
[90.]
A. Obermayer, K. Göstl, G. Walli, T. Benesch.
Chronic venous leg ulcers benefit from surgery: long-term results from 173 legs.
J Vasc Surg, 44 (2006), pp. 572-579
[91.]
W.B. van Gent, W.C. Hop, M.C. van Praag, A.J. Mackaay, E.M. de Boer, C.H. Wittens.
Conservative versus surgical treatment of venous leg ulcers: a prospective, randomized, multicenter trial.
J Vasc Surg, 44 (2006), pp. 563-571
[92.]
O. Nelzén, I. Fransson.
True long-term healing and recurrence of venous leg ulcers following SEPS combined with superficial venous surgery: a prospective study.
Eur J Vasc Endovasc Surg, 34 (2007), pp. 605-612
[93.]
R. Gesto-Castromil.
El laboratorio de exploraciones funcionales. Relación coste/beneficio.
Angiología, 56 (2004), pp. 299-300
[94.]
E. Ros-Die.
El laboratorio vascular y la clínica.
Angiología, 56 (2004), pp. 277-278
[95.]
J.M. Ramirez.
Ecografía para cirujanos.
Prensas Universitarias de Zaragoza, (2007),
[96.]
J. Arenas-Ricart, R. Sellés-Dechent, C. Ballester-Ibáñez, J. Pérez-Monreal, S. González-Vila, J. Ruiz del Castillo.
Cirugía clásica frente a 3-S safenectomía para el tratamiento de las varices del miembro inferior.
Cir Esp, 79 (2006), pp. 370-374
[97.]
F. Díaz Gómez, P. Castells Ferrer, E. Recio Valenzuela, J. García Armengol, C. Fernández Martínez, J.V. Roig Vila.
Estudio comparativo entre la flebografía poplítea dinámica y el eco-Doppler en color en el diagnóstico de la insuficiencia venosa en el hueco poplíteo.
Cir Esp, 63 (1998), pp. 373-377
[98.]
J. Sánchez Beorlegui, J.L. García Calleja, M. Fernández Ruiz, F. Lamata Hernández, S. Gangutia Hernández, E. Córdoba Díaz de Laspra.
Variantes anatómicas del confluente safeno-femoral. Estudio prospectivo en 122 disecciones quirúrgicas consecutivas.
Cir Esp, 67 (2000), pp. 164-167
[99.]
L. Senoseain del Campo, M.E. del Campo Pena.
El origen del reflujo sanguíneo en las varices esenciales. Análisis eco- Doppler de 200 miembros inferiores.
Cir Esp, 64 (1998), pp. 339-346
Copyright © 2009. Asociación Española de Cirujanos
Download PDF
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos