Obesity and lower limb venous disease – The epidemic of phlebesity

2016 ◽  
Vol 32 (4) ◽  
pp. 227-233 ◽  
Author(s):  
Huw OB Davies ◽  
Matthew Popplewell ◽  
Rishi Singhal ◽  
Neil Smith ◽  
Andrew W Bradbury
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Disease ◽  
Obese Patients ◽  
Obese People ◽  
Vein Thrombosis ◽  
Deep Vein

Introduction Lower limb venous disease affects up to one half, and obesity up to one quarter, of the adult population. Many people are therefore affected by, and present to health services for the treatment of both conditions. This article reviews the available evidence of pathophysiological and clinical relationship between obesity and varicose veins, chronic venous insufficiency and ulceration and deep vein thrombosis. Methods A literature search of PubMed and Cochrane libraries was performed in accordance with PRISMA statement from 1946 to 2015, with further article identification from following cited references for articles examining the relationship between obesity and venous disease. Search terms included obesity, overweight, thrombosis, varicose veins, CEAP, chronic venous insufficiency, treatment, endovenous, endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis. Results The proportion of the population suffering from lower limb venous disease and obesity is increasing. Obesity is an important risk factor for all types of lower limb venous disease, and obese patients with lower limb venous disease are more likely to be symptomatic as a result of their lower limb venous disease. The clinical diagnosis, investigation, imaging and treatment of lower limb venous disease in obese people present a number of challenges. The evidence base underpinning medical, surgical and endovenous management of lower limb venous disease in obese people is limited and such treatment may be associated with worse outcomes and increased risks when compared to patients with a normal body mass index. Conclusion Lower limb venous disease and obesity are both increasingly common. As such, phlebologists will be treating ever greater numbers of obese patients with lower limb venous disease, and clinicians in many other specialties are going to be treating a wide range of obesity-related health problems in people with or at risk of lower limb venous disease. Unfortunately, obese people have been specifically excluded from many, if not most, of the pivotal studies. As such, many basic questions remain unanswered and there is an urgent need for research in this challenging and increasingly prevalent patient group.

scholarly journals Post-thrombotic syndrome in children: current state of affairs

2020 ◽  
Vol 19 (3) ◽  
pp. 139-143
Author(s):  
M. Yu. Zhukov ◽  
N. N. Mitrakov ◽  
P. A. Zharkov
Keyword(s):  
Deep Vein Thrombosis ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Published Data ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Current State ◽  
Organ Tissue ◽  
State Of Affairs ◽  
Deep Vein

Post-thrombotic syndrome (PTS) is one of the most significant complications that develops in patients after deep vein thrombosis. Patients with PTS have persistent and often worsening chronic venous insufficiency which can lead to permanent impairment of the affected organ, tissue or limb. Despite their importance, the issues of diagnosis and prevention of PTS in children are understudied in Russia. This paper is based on the analysis of recently published data and presents the current state of affairs regarding PTS in pediatrics.

Preventing and treating deep vein thrombosis

1992 ◽  
Vol 30 (3) ◽  
pp. 9-12
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Surgical Patients ◽  
Fatal Pulmonary Embolism ◽  
Venous Ulceration ◽  
Vein Thrombosis ◽  
Hospital Patients ◽  
Deep Vein

Deep vein thrombosis (DVT) is a common event in hospital patients.1 The diagnosis is often missed, and its most serious sequel, fatal pulmonary embolism (PE) is still detected in 10% of hospital autopsies.2–3 DVT also commonly leads to chronic venous insufficiency and venous ulceration, treatment of which costs the NHS about £600 million a year.4 Deep vein thrombosis can be prevented in 60–75% of surgical patients,5 but many different prophylactic regimens are used, and some surgeons still use none.6 We discuss here who should receive prophylaxis, how it should be given, and review the treatment of established venous thrombosis.

Comparison of Three Exercises for Evaluation of the Calf Muscle Pump

1995 ◽  
Vol 10 (1) ◽  
pp. 23-27 ◽  
Author(s):  
S. Ohgi ◽  
K. Tanaka ◽  
T. Maeda ◽  
Y. Kanaoka ◽  
M. Ikebuchi ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Calf Muscle ◽  
Venous Disease ◽  
Muscle Pump ◽  
Vein Thrombosis ◽  
Calf Muscle Pump ◽  
Primary Varicose Veins ◽  
Deep Vein

Objective: To evaluate accurately the calf muscle pump in patients with venous insufficiency using foot vein pressure measurements during three different exercises. Design: Prospective study in three groups, comparing patients with venous disease with controls. Setting: Second Department of Surgery, Tottori University Faculty of Medicine. Patients: Twenty normal legs, 29 legs previously affected by deep vein thrombosis and 36 legs with primary varicose veins. Main outcome measures: The foot vein pressure was measured during ankle dorsiflexions, knee-bending and walking on the spot at 40 paces per minute during which minimum ambulatory venous pressure (AVP) and venous refilling time (VRT) were assessed. Results: The three groups differed significantly from each other in AVP and VRT after dorsiflexion and in AVP during walking on the spot, but not after knee-bending. Conclusion: Dorsiflexion is the most useful exercise distinguishing various severities of venous insufficiency, but walking on the spot is more useful for accurately evaluating the calf muscle pump.

scholarly journals De preventie van diepe veneuze trombose

1994 ◽  
Vol 13 (2) ◽  
pp. 36-45
Author(s):  
M. Verstraete
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Clinical Diagnosis ◽  
Varicose Veins ◽  
Solid Tumours ◽  
Obese Patients ◽  
True Incidence ◽  
Vein Thrombosis ◽  
Deep Vein

It is generally held that the clinical diagnosis of deep vein thrombosis constitutes a gross underestimate of the true incidence of the disease. Most cases of venous thrombosis occur after operation, during pregnancy and the puerperium, during prolonged immobilisation, in obese patients with varicose veins or in patients with solid tumours.

scholarly journals Practical experience with adjustable, non-extensible compression bandages in patients with nonhealing trophic ulcers

2021 ◽  
pp. 52-58
Author(s):  
S. P. Zotov ◽  
N. B. Shishmentsev ◽  
V. V. Vladimirskiy ◽  
V. Yu. Bogachev
Keyword(s):  
Deep Vein Thrombosis ◽  
Chronic Venous Insufficiency ◽  
Clinical Case ◽  
Venous Insufficiency ◽  
Compression Bandage ◽  
Working Pressure ◽  
Vein Thrombosis ◽  
Resting Pressure ◽  
The Right ◽  
Deep Vein

Introduction. The adjustable non-extensible compression bandage is a new product recently registered and approved for clinical use in the Russian Federation. The main indications for its use are severe chronic venous insufficiency and lymphedema, which cannot be corrected with traditional bandages and flat knit medical compressions. On the affected limb, an adjustable, non-extensible compression bandage allows high working pressure to be created at low, approaching zero, resting pressure. And depending on the tension of the velcro fastener, the working pressure can be adjusted between 20 and 50 mmHg or more. At the same time, the patient can maintain the actual pressure independently, regardless of the reduction in the volume of the limb. Low resting pressure makes it possible to use this type of bandage all day without the discomfort that is typical for traditional bandages and therapeutic compression knitwear felt by patients during sleep.Clinical case. Patient diagnosed with chronic lymphovenous insufficiency in both lower limbs. CEAP class C5 on the left, CEAP class C5 on the right. After undergoing acute iliofemoral thrombosis on the left, complicated by thromboembolism of small branches of the pulmonary artery, he was treated in a specialized vascular unit, where anticoagulant, antiplatelet and phlebotropic therapy was carried out. After the second episode of deep vein thrombosis, pain in the lower extremities, swelling of the tibia, skin itching and the appearance of small trophic ulcers started to worry, which temporarily closed against the background of increased compression therapy, prescription of phlebotropic drugs and local treatment. Subsequently, large trophic ulcers were formed on the inner surface of both shins above the ankle joint. An adjustable, non-extensible compression bandage was used on the right shin to correct chronic venous insufficiency and heal a trophic ulcer. The use of an adjustable, non-extensible compression bandage within 2 to 4 weeks resulted in the disappearance of chronic swelling, reduction of the pain syndrome, and then 5 months later – led to a reduction in trophic ulcer and the disappearance of infection signs.Conclusions. This clinical case of the successful closure of a large infected trophic ulcer that occurred after deep vein thrombosis against the background of coxarthrosis and which remained unhealed for 7 years clearly illustrates the broad possibilities of an adjustable, nonextensible compression bandage.

Acute Deep Vein Thrombosis Treated with Porcine Plasmin

1974 ◽  
Vol 32 (02/03) ◽  
pp. 468-482 ◽  
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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