Treatment of Venous Ulceration by Injection Sclerotherapy and Compression Hosiery: A 5-Year Study

1992 ◽  
Vol 7 (1) ◽  
pp. 23-26 ◽  
Author(s):  
E. Dinn ◽  
M. Henry
Keyword(s):  
Recurrence Rate ◽  
Varicose Vein ◽  
Venous Pressure ◽  
Previous History ◽  
Injection Sclerotherapy ◽  
Ulcer Recurrence ◽  
Compression Stockings ◽  
Venous Ulceration ◽  
Venous Ulcers ◽  
Graduated Compression Stockings

Objective: To determine whether the use of graduated compression stockings reduces the rate of recurrence of venous ulceration. Design: Prospective, closed, non-randomised study of 126 patients with a previous history of venous ulceration for five years. Setting: The Varicose Vein Clinic of Sir Patrick Dun's and Adelaide Hospitals. Patients: 126 patients attending the Varicose Vein Clinic who had undergone successful healing of venous ulcers by injection compression sclerotherapy. Intervention: All patients underwent clinical examination and venous pressure measurement, and were then fitted with graduated compression stockings. Those patients dropping out of the study (21) were used as a comparison group. Main outcome measure: The recurrence rate of venous ulcers. Results: At the end of the 5 year study period patients were divided into 3 groups – those who had ulcer recurrence (33), those who were free of ulcers (72), and those (21) who had dropped out of the study, the last group showing a higher recurrence rate than those who had worn stockings.

Compression Treatment of Chronic Venous Ulceration: A Review

2000 ◽  
Vol 15 (3-4) ◽  
pp. 162-168 ◽  
Author(s):  
G. L. Moneta ◽  
A. D. Nicoloff ◽  
J. M. Porter
Keyword(s):  
Medical Literature ◽  
Compression Therapy ◽  
Clinical Situation ◽  
Ulcer Recurrence ◽  
Compression Stockings ◽  
Venous Ulceration ◽  
Elastic Compression ◽  
Future Goals ◽  
Venous Ulcers ◽  
The Individual

Objective: To review the recent medical literature with regard to the use of compressive therapy in healing and preventing the recurrence of venous ulceration. Methods: Searches of Medline and Embase medical literature databases. Appropriate non-indexed journals and textbooks were also reviewed. Synthesis: Elastic compression therapy is regarded as the ‘gold standard’ treatment for venous ulceration. The benefits of elastic compression therapy in the treatment of venous ulceration may be mediated through favourable alterations in venous haemodynamics, micro-circulatory haemodynamics and/or improvement in subcutaneous Starling forces. Available data indicate compressive therapy is highly effective in healing of the large majority of venous ulcers. Elastic compression stockings, Unna boots, as well as multi-layer elastic wraps, have all been noted to achieve excellent healing rates for venous ulcers. In compliant patients it appears that approximately 75% of venous ulcers can be healed by 6 months, and up to 90% by 1 year. Non-healing of venous ulcers is associated with lack of patient compliance with treatment, large and long-standing venous ulceration and the coexistence of arterial insufficiency. Recurrence of venous ulceration is, however, a significant problem after healing with compressive therapy, even in compliant patients; approximately 20-30% of venous ulcers will recur by 2 years. Conclusions: Compressive therapy is capable of achieving high rates of healing of venous ulceration in compliant patients. Various forms of compression, including elastic, rigid and multi-layer dressings, are available depending on physician preference, the clinical situation and the needs of the individual patient. Compressive therapy, while effective, remains far from ideal. The future goals are to achieve faster healing of venous ulceration, less painful healing and freedom from ulcer recurrence.

Varicose Veins: optimum compression after surgery and sclerotherapy

1990 ◽  
Vol 76 (2) ◽  
pp. 101-104
Author(s):  
P. J. Shouler ◽  
P. C. Runchman
Keyword(s):  
Surgical Treatment ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Compression Stocking ◽  
Compression Stockings ◽  
Varicose Vein Surgery ◽  
High Compression ◽  
Graduated Compression Stockings ◽  
Non Surgical Treatment

SummaryGraduated compression stockings are used in both surgical and non-surgical treatment of varicose veins. In a trial of high versus low compression stockings (40mmHg vs 15mmHg at ankle) after varicose vein surgery, both were equally effective in controlling bruising and thrombophlebitis, but low compression stockings proved to be more comfortable.In a further trial after sclerotherapy, high compression stockings alone produced comparable results to Elastocrepe® bandages with stockings. It is concluded that after varicose vein surgery low compression stockings provide adequate support for the leg and that after sclerotherapy, bandaging is not required if a high compression stocking is used.

Long-Term Clinical Results following Correction of Incompetent Superficial and Perforating Veins in Patients with Deep Venous Incompetence and Ulcers

1993 ◽  
Vol 8 (3) ◽  
pp. 128-131 ◽  
Author(s):  
H. Åkesson
Keyword(s):  
Venous Pressure ◽  
Clinical Results ◽  
Venous Ulceration ◽  
Perforating Veins ◽  
Venous Ulcers ◽  
Increased Risk ◽  
A Prospective Study ◽  
Volumetric Measures

Objectives: To assess the presence of venous ulcers following stripping of the saphenous vein and ligation of perforating veins in patients with deep venous incompetence. Design: Retrospective follow-up after a median of 41 months following surgery. Patients: Thirty operated limbs in 25 patients with venous ulcers, originally entering a prospective study of physiological changes following surgery for venous insufficiency. Interventions: An interview regarding absence of ulcers, expressed as a percentage of the follow-up time after surgery – the ‘ulcer-free period’. Correlation with ambulatory venous pressure (AVP) and foot volumetric measures following surgery. Main outcome measures: The presence or absence of venous ulcers. Results: The ulcer-free period for the whole group was 76%. There was a significant (p<0.05) difference in the ulcer-free period in limbs with an AVP below 60 mmHg (89%) compared with limbs with a higher AVP (70%). Conclusion: Failure to normalize AVP with surgery results in persistent high venous pressure and an increased risk of venous ulceration recurrences.

Should the Incompetent Saphenous Vein be Stripped to the Ankle?

1986 ◽  
Vol 1 (1) ◽  
pp. 33-36 ◽  
Author(s):  
David Negus
Keyword(s):  
Recurrence Rate ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Neurological Complications ◽  
Saphenous Nerve ◽  
Neurological Symptoms ◽  
Injection Sclerotherapy ◽  
Long Saphenous Vein ◽  
Nerve Trauma

Long saphenous stripping from ankle to groin is followed by an unacceptably high (23-58%) instance of neurological complications resulting from saphenous nerve trauma. Sapheno-femoral ligation without stripping avoids this complication, but with a reported varicose vein recurrence rate of 60%. Stripping the incompetent long saphenous vein from groin to upper calf in 96 legs of 71 patients has been followed by saphenous neurological symptoms in 4.2%, with a recurrence rate of 12.5%, half of which were suitable for injection sclerotherapy.

Graduated Compression Elastic Stockings Reduce Lipodermatosclerosis and Ulcer Recurrence

2000 ◽  
Vol 15 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Y. K. Vandongen ◽  
M. C. Stacey
Keyword(s):  
Controlled Trial ◽  
Venous Ulcer ◽  
Control Group ◽  
Venous Disease ◽  
Ulcer Recurrence ◽  
Compression Stockings ◽  
Venous Ulceration ◽  
Tertiary Teaching ◽  
Elastic Stockings ◽  
Randomised Controlled

Objective: To assess the effect of elastic stockings on reducing the area of lipodermatosclerosis in patients with healed venous ulceration. Design: Patients in this study were part of a randomised controlled trial to assess elastic stockings in preventing venous ulcer recurrence. Setting: Leg ulcer clinic at a tertiary teaching hospital. Patients: Consecutive consenting patients with leg ulcers due to venous disease alone, that had healed 2 weeks previously. Interventions: Patients were randomised to below-knee graduated compression stockings (Venosan 2003) or no stockings. Main outcome measures: Patients had the area of lipodermatosclerosis measured on admission to the study and at 6-monthly intervals. Time to ulcer recurrence was also recorded for a 2-year follow-up period. Results: One hundred and fifty-three patients were randomised to the main study (stockings 72, no stockings 81); 52 had re-ulcerated by 6 months (15 stockings, 37 no stockings). Lipodermatosclerosis was significantly reduced after 6 and 12 months in those patients wearing stockings but not in the control group (repeat measures ANOVA p = 0.01, p = 0.04). The initial area of lipodermatosclerosis was significantly larger in those patients who re-ulcerated within 2 years of entering the study compared with those who did not re-ulcerate (re-ulceration, 293 cm2; no re-ulceration, 50 cm2). Conclusions: Elastic stockings alone can improve the skin changes of lipodermatosclerosis and lower the rate of ulcer recurrence.

Systematic Reviews of Prevention of Venous Ulcer Recurrence

2001 ◽  
Vol 16 (1) ◽  
pp. 20-23 ◽  
Author(s):  
E. A. Nelson
Keyword(s):  
Systematic Reviews ◽  
Data Extraction ◽  
Venous Ulcer ◽  
Ulcer Recurrence ◽  
Recurrence Rates ◽  
Venous Ulceration ◽  
Treatment Regimens ◽  
Venous Ulcers ◽  
Weak Evidence ◽  
Randomised Controlled

Aim: To illustrate and discuss the role of systematic reviews in assessing the effect of interventions used in preventing recurrence of venous ulceration. Method: Systematic review of randomised controlled trials (RCTs) reporting the recurrence of venous ulcers. We searched the Cochrane Wounds Group specialised trial register in June 2000. This contains results of searches for RCTs in 18 electronic databases and hand searches. Trials were assessed for inclusion by two people and data extraction was performed using a standard proforma. Synthesis: We found weak evidence that wearing compression hosiery reduces recurrence rates. There was insufficient evidence for the effectiveness of drugs, vein surgery, exercise or leg elevation. Conclusions: Where systematic reviews provide clear implications for practice are found, clinicians can incorporate these into treatment regimens. Where results indicate that there is clinical uncertainty, as in the prevention of recurrence, this can assist commissioners and researchers in prioritising research questions.

The treatment of venous leg ulcers with a specifically designed compression stocking kit

Phlebologie ◽  
2008 ◽  
Vol 37 (04) ◽  
pp. 191-197 ◽  
Author(s):  
V. Mattaliano ◽  
G. Mosti ◽  
V. Gasbarro ◽  
M. Bucalossi ◽  
W. Blättler ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Compression Stocking ◽  
Leg Ulcers ◽  
Compression Stockings ◽  
Venous Leg Ulcers ◽  
Venous Ulcers ◽  
Time To Completion ◽  
Validated Questionnaire ◽  
First Choice ◽  
Ankle Movement

SummaryTraditionally, venous leg ulcers are treated with firm nonelastic bandages. Medical compression stockings are not the first choice although comparative studies found them equally effective or superior to bandages. Patients, methods: We report on a multi-center randomized trial with 60 patients treated with either short stretch multi-layer bandages or a two-stocking system (Sigvaris® Ulcer X® kit). Three patients have been excluded because their ankle movement was restricted to the extent that they could not put on the stockings and 1 patient withdrew consent. Patient characteristics and ulcer features were evenly distributed. The proportion of ulcers healed within 4 months and the time to completion of healing were recorded. Subjective appraisal was assessed with a validated questionnaire. Results: Complete wound closure was achieved in 70.0% (21 of 30) with bandages and in 96.2% (25 of 26) with the ulcer X kit (p = 0.011). Ulcers with a diameter of up to about 4cm healed twice as rapidly, the larger ones as fast with the stocking kit as with bandages. The sum of problems encountered with bandages was significantly greater than that observed with the stocking kit (p < 0.0001). Pain at night and in the morning was absent with stockings but reported by 40% and 20% in the bandage group, respectively. The cardinal features associated with delayed or absent healing were ulcer size and pain. Conclusions: Common venous ulcers can readily be treated with the ulcer X compression kit provided the ankle movement allow its painless donning. Bandages, even when applied by the most experienced staff are less effective and cause more problems.

Healing venous ulcers with different modalities of leg compression

Phlebologie ◽  
2006 ◽  
Vol 35 (05) ◽  
pp. 349-355 ◽  
Author(s):  
E. O. Brizzio ◽  
G. Rossi ◽  
A. Chirinos ◽  
I. Cantero ◽  
G. Idiazabal ◽  
...  
Keyword(s):  
Wound Care ◽  
Univariate Analysis ◽  
Compression Therapy ◽  
Healing Time ◽  
Clinical Parameters ◽  
Compression Stockings ◽  
Local Pressure ◽  
Ulcer Size ◽  
Venous Ulcers ◽  
Unexpected Findings

Summary Background: Compression therapy (CT) is the stronghold of treatment of venous leg ulcers. We evaluated 5 modalities of CT in a prospective open pilot study using a unique trial design. Patients and methods: A group of experienced phlebologists assigned 31 consecutive patients with 35 venous ulcers (present for 2 to 24 months with no prior CT) to 5 different modalities of leg compression, 7 ulcers to each group. The challenge was to match the modality of CT with the features of the ulcer in order to achieve as many healings as possible. Wound care used standard techniques and specifically tailored foam pads to increase local pressure. CT modalities were either stockings Sigvaris® 15-20, 20-30, 30-40 mmHg, multi-layer bandages, or CircAid® bandaging. Compression was maintained day and night in all groups and changed at weekly visits. Study endpoints were time to healing and the clinical parameters predicting the outcome. Results: The cumulative healing rates were 71%, 77%, and 83% after 3, 6, and 9 months, respectively. Univariate analysis of variables associated with nonhealing were: previous surgery, presence of insufficient perforating and/or deep veins, older age, recurrence, amount of oedema, time of presence of CVI and the actual ulcer, and ulcer size (p <0.05-<0.001). The initial ulcer size was the best predictor of the healing-time (Pearson r=0.55, p=0.002). The modality of CT played an important role also, as 19 of 21 ulcers (90%) healed with stockings but only 8 of 14 with bandages (57%; p=0.021). Regression analysis allowed to calculate a model to predict the healing time. It compensated for the fact that patients treated with low or moderate compression stockings were at lower risk of non-healing. and revealed that healing with stockings was about twice as rapid as healing with bandages. Conclusion: Three fourths of venous ulcers can be brought to healing within 3 to 6 months. Healing time can be predicted using easy to assess clinical parameters. Irrespective of the initial presentation ulcer healing appeared more rapid with the application of stockings than with bandaging. These unexpected findings contradict current believes and require confirmation in randomised trials.

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