Response to “Re. Lower Limb Deep Vein Diameters Beneath Medical Compression Stockings in the Standing Position”

Background A too high resting pressure of compression devices is poorly tolerated and may cause skin defects, especially in patients with concomitant arterial occlusive disease. Aim To investigate whether low compression pressure will improve venous pumping function in patients with venous incompetence. Material and methods Venous pumping function was assessed in 20 patients with severe reflux in the great saphenous vein by measuring ejection fraction (EF) using strain-gauge plethysmography. Measurements were repeated after application of knee-high medical compression stockings and of inelastic bandages applied with a pressure of 20, 40 and 60 mmHg in the supine position. Results EF was significantly reduced compared with healthy controls. Compression stockings exerting a median pressure of 27 mmHg (interquartile range [IQR] 25–29) in the supine and 30.5 mmHg (IQR 28.25–34.25) in the standing position produced a moderate, non-significant improvement of EF of 17%. Inelastic bandages with a resting pressure of 20.5 mmHg (IQR 20–22) in the supine position resulting in a standing pressure of 36 mmHg (IQR 33–40.75) led to a significant increase of EF of 61.5% ( P < 0.01). A further increase of the resting pressure to 40 and 60 mmHg achieved an increase of the EF of 91% and 98%, respectively ( P < 0.001). Conclusions In patients with venous pumping failure, inelastic bandages produce a significant pressure-dependent increase of EF. A significant improvement in venous pumping function was achieved with inelastic bandages even at a resting pressure of 20 mmHg.

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Randomized trial of medical compression stockings versus two-layer short-stretch bandaging in the management of venous leg ulcers

Phlebologie ◽

10.1055/s-0037-1622268 ◽

2009 ◽

Vol 38 (04) ◽

pp. 157-163 ◽

Cited By ~ 9

Author(s):

A. Franek ◽

L. Brzezinska-Wcislo ◽

E. Blaszczak ◽

A. Polak ◽

J. Taradaj

Keyword(s):

Drug Therapy ◽

Randomized Clinical Trials ◽

Therapy Group ◽

Long Term Results ◽

Leg Ulcers ◽

Compression Stockings ◽

Venous Leg Ulcers ◽

Group A ◽

Group B ◽

Medical Compression Stockings

SummaryA prospective randomized clinical trial was undertaken to compare a medical compression stockings with two-layer short-stretch bandaging in the management of venous leg ulcers. Study endpoints were number of completely healed wounds and the clinical parameters predicting the outcome. Patients, methods: Eighty patients with venous leg ulcers were included in this study, and ultimately allocated into two comparative groups. Group A consisted of 40 patients (25 women, 15 men). They were treated with the compression stockings (25–32 mmHg) and drug therapy. Group B consisted of 40 patients (22 women, 18 men). They were treated with the short-stretch bandages (30–40 mmHg) and drug therapy, administered identically as in group A. Results: Within two months the 15/40 (37.50%) patients in group A and 5/40 (12.50%) in group B were healed completely (p = 0.01). For patients with isolated superficial reflux, the healing rates at two months were 45.45% (10/22 healed) in group A and 18.18% (4/22 healed) in group B (p = 0.01). For patients with superficial plus deep reflux, the healing rates were 27.77% (5/18 healed) in group A and 5.55% (1/18 healed) in group B (p = 0.002). Comparison of relative change of the total surface area (61.55% in group A vs. 23.66% in group B), length (41.67% in group A vs. 27.99% in group B), width (46.16% in group A vs. 29.33% in group B), and volume (82.03% in group A vs. 40.01% in group B) demonstrated difference (p = 0.002 in all comparisons) in favour of group A. Conclusion: The medical compression stockings are extremely useful therapy in enhancement of venous leg ulcer healing (both for patients with superficial and for patients who had superficial plus deep reflux). Bandages are less effective (especially for patients with superficial plus deep reflux, where the efficiency compared to the stockings of applied compression appeared dramatically low). These findings require confirmation in other randomized clinical trials with long term results.

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Acute Deep Vein Thrombosis Treated with Porcine Plasmin

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647715 ◽

1974 ◽

Vol 32 (02/03) ◽

pp. 468-482 ◽

Cited By ~ 2

Author(s):

O Storm ◽

P Ollendorff ◽

E Drewsen ◽

P Tang

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Initial Dose ◽

Treated Group ◽

Allergic Reactions ◽

Double Blind ◽

Vein Thrombosis ◽

Thrombolytic Effect ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

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Controlled Trial of the Sequential Use of Streptokinase and Ancrod in the Treatment of Deep Vein Thrombosis of Lower Limb

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649223 ◽

1977 ◽

Vol 37 (02) ◽

pp. 222-232 ◽

Cited By ~ 12

Author(s):

D. A Tibbutt ◽

C. N Chesterman ◽

E. W Williams ◽

T Faulkner ◽

A. A Sharp

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Improvement ◽

Anticoagulant Therapy ◽

Lower Limb ◽

Oral Anticoagulant ◽

Controlled Trial ◽

Oral Anticoagulant Therapy ◽

Control Group ◽

Vein Thrombosis ◽

Deep Vein

SummaryTreatment with streptokinase (‘Kabikinase’) was given to 26 patients with venographically confirmed deep vein thrombosis extending into the popliteal vein or above. Treatment was continued for 4 days and the patients were allocated randomly to oral anticoagulant therapy or a course of treatment with ancrod (‘Arvin’) for 6 days followed by oral anticoagulant therapy. The degree of thrombolysis as judged by further venographic examination at 10 days was not significantly different between the 2 groups. The majority of patients showed clinical improvement but there was no appreciable difference between the groups at 3 and 6 months. Haemorrhagic complications were a more serious problem during the period of treatment with ancrod than during the equivalent period in the control group.

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Effect of Punarnavadi Mandoor and Shiva Gutika in Acute Deep Vein Thrombosis - A Case Report

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i4.9371 ◽

2017 ◽

Vol 2 (4) ◽

Author(s):

Wasedar Vishwanath S. ◽

Pusuluri YVSM Krishna ◽

Dani Harshikha

Keyword(s):

Lower Limb ◽

Blood Clot ◽

Acute Case ◽

Vein Thrombosis ◽

Oral Medications ◽

Doppler Study ◽

Brown Discoloration ◽

Left Lower Limb ◽

Life Threatening ◽

Deep Vein

Objectives: To minimise the dose of Anti-platelet drugs and to treat the acute case of DVT through Ayurvedic oral medications. Methods: The present diagnosed case of DVT approached to OPD of KLE BMK Ayurveda Hospital with a complaints of swelling and pain in the calf muscle of the left lower limb associated with reddish brown discoloration in the foot and occasionally nasal and gum bleeding was treated consequently for 5 months with Punarnavadi Mandoor and Shiva Gutika orally. Results: There is significant decrease in the symptoms of DVT and also major changes seen in Venous Colour Doppler study of the left lower limb. Conclusion: Acute DVT is caused by a blood clot in a deep vein and can be life threatening as it may leads to serious complication like pulmonary embolism which can be cured through Ayurvedic oral medications.

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Comfort Properties of Medical Compression Stockings from Biodesigned and Cotton Fibers

Fibers and Polymers ◽

10.1007/s12221-021-0615-8 ◽

2021 ◽

Author(s):

Ferid Kırcı ◽

Ecem Karamanlargil ◽

Sena Cimilli Duru ◽

Banu Nergis ◽

Cevza Candan

Keyword(s):

Cotton Fibers ◽

Compression Stockings ◽

Medical Compression Stockings

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Internal valvuloplasty combined with sleeve wrapping in the treatment of severe deep venous incompetence: A case report

Vascular ◽

10.1177/1708538121990121 ◽

2021 ◽

pp. 170853812199012

Author(s):

Yingfeng Wu ◽

Libing Wei ◽

Xixiang Gao ◽

Yixia Qi ◽

Zhu Tong ◽

...

Keyword(s):

Lower Limb ◽

Venous Insufficiency ◽

Femoral Vein ◽

Duplex Ultrasound ◽

Vein Wall ◽

Polyester Urethane ◽

Left Lower Limb ◽

Deep Vein ◽

Color Duplex Ultrasound

Background The main cause of severe chronic venous insufficiency is deep venous incompetence. Deep venous reconstructive surgeries are reserved for cases that do not show a good response to conservative therapies. Method We present the case of a 68-year-old man presenting with swelling, pain, and pigmentation in his left lower limb for 14 years and ulcers for 10 years. Descending venography identified a Kistner’s grade IV reflux in the deep vein of the left lower limb. Internal valvuloplasty was performed following Kistner’s method. Meanwhile, external wrapping with a 1-cm-wide polyester-urethane vascular patch was performed to strengthen the vein wall in the venospasm condition. Results Symptoms were immediately relieved postoperatively. Refractory ulcers healed five months after the procedure. At the six-month follow-up, color duplex ultrasound of the deep vein of the left lower limb showed no reflux in the proximal segment of the femoral vein. Conclusion Internal valvuloplasty combined with sleeve wrapping is feasible in the treatment of severe deep venous incompetence with good short-term results.

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