Effect of leg elevation on healing, venous velocity and ambulatory venous pressure in venous ulceration

2005 ◽  
Vol 20 (2) ◽  
pp. 87-94 ◽  
Author(s):  
F P Dix ◽  
B Reilly ◽  
M C David ◽  
D Simon ◽  
E Dowding ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Current Treatment ◽  
Leg Ulcers ◽  
Venous Flow ◽  
Cross Sectional ◽  
Venous Ulceration ◽  
Postural Changes ◽  
Venous Surgery

Objective: Current treatment of venous leg ulcers (VLU) includes four-layer bandaging, appropriate superficial venous surgery and leg elevation. The aims of this study were to: investigate a device designed to measure leg elevation; assess how long patients elevate; and to assess the effect of elevation on ulcer healing, femoral vein velocity (FVV) and popliteal vein cross-sectional area (PVCSA), and venous pressure. Patients and methods: A datalogger and accelerometer were manufactured to measure leg elevation. The device was validated in eight control subjects; elevation was measured in 24 patients with VLU. Ulcers were traced over six weeks in 29 patients and elevation measured to correlate healing with elevation. Ten patients and 10 controls underwent duplex measurement of FVV and PVCSA to measure flow in relation to posture; nine patients underwent measurement of venous pressure with postural changes. Non-parametric statistical analysis was used. Results: The datalogger accurately recorded all episodes of elevation. Median (range) elevation time was 53 (0–350) mins/24 h; correlation between ulcer healing and elevation was poor at 0.103 ( P=0.616, Spearman); change in posture from sitting to supine produced a significant increase in median (range) FVV from 11 (7–24) to 34 (22–66) in VLU ( P=0.005) and 15 (12–34) to 38 (16–69) in controls ( P=0.005, Wilcoxon). Change in posture from supine to 25 degrees elevation produced no change in FVV in either group ( P=0.173 in VLU, P=0.327 in controls, Wilcoxon). In VLU, sitting PVCSA was 1.07 (0.51–1.45) cm2. Supine position significantly reduced the area to 0.46 (0.27–1.01) cm2 ( P=0.005, Wilcoxon). On elevation to 25°, PVCSA was further reduced to 0.28 (0.07–0.63) cm2 ( P=0.058, Wilcoxon). In controls, sitting PVCSA was 0.79 (0.31–1.56) cm2, supine was reduced to 0.46 (0.27–1.09) cm2 ( P=0.047, Wilcoxon) and on elevation was reduced to 0.23 (0.10–0.44) cm2 ( P=0.005, Wilcoxon). Venous pressure standing was 99 (73–116) mmHg, reduced to 76 (53–113) mmHg on sitting ( P=0.084), and further reduced to 23 (7–36) mmHg supine ( P=0.008, Wilcoxon). Conclusions: Leg elevation in patients with VLU is poor but can be accurately measured. Elevation in the presence of compression may not improve ulcer healing. Postural changes of the leg can produce an increase in deep venous flow and a reduction in venous pressure.

Effect of foam sclerotherapy on healing and long-term recurrence in chronic venous leg ulcers

2013 ◽  
Vol 28 (3) ◽  
pp. 140-146 ◽  
Author(s):  
S R Kulkarni ◽  
F J A Slim ◽  
L G Emerson ◽  
C Davies ◽  
R A Bulbulia ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Healing Rate ◽  
Leg Ulcers ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Recurrence Rates ◽  
Venous Ulceration ◽  
Venous Leg Ulcers ◽  
Venous Surgery

Introduction The ESCHAR trial showed that superficial venous surgery and compression in chronic venous ulceration achieved a 24-week healing rate of 65% and 12-month recurrence rate of 12%. Foam sclerotherapy treatment is an alternative to surgery. The aim of this study is to assess the effect of foam sclerotherapy on ulcer healing and recurrence in chronic venous leg ulcers. Methods Chronic venous leg ulcers (CEAP [clinical, aetiological, anatomical and pathological elements] 5 and CEAP 6) with superficial venous reflux were treated between March 2006 and June 2011 with ultrasound-guided foam sclerotherapy and compression. Venous duplex was performed on all legs before and after treatment. Twenty-four-week ulcer healing and one- and four-year ulcer recurrence rates were calculated using Kaplan–Meier survival analysis. Results Two hundred legs (186 patients) with chronic venous ulcers (CEAP 5: n = 163 and CEAP 6: n = 37) were treated with foam sclerotherapy. Complete occlusion was achieved in 185/200 (92.5%) limbs, short segment occlusion in 14/200 (7%) limbs and one leg segment failed to occlude. One patient suffered an asymptomatic non-occlusive deep vein thrombosis (DVT) diagnosed on duplex scan at one week and one presented with an occlusive DVT three weeks following a normal scan at one week. One patient developed an asymptomatic occlusive DVT at two weeks following a non-occlusive DVT diagnosed on initial one-week scan. Eighteen patients were lost to follow-up (3 moved away and 15 died of unrelated causes). The 24-week healing rate was 71.1% and one- and four-year recurrence rates were 4.7% and 28.1%, respectively. Conclusion Foam sclerotherapy is effective in abolition of superficial venous reflux and may contribute to similar ulcer healing and long-term recurrence rates to superficial venous surgery. Foam sclerotherapy is an attractive alternative to surgery in this group of patients.

Microvascular Evaluation by Laser—Dopper Flowmetry of the Effects of Centellase in the Treatment of Severe Venous Hypertension and Leg Ulcers

1987 ◽  
Vol 2 (3) ◽  
pp. 189-195 ◽  
Author(s):  
G. Belcaro
Keyword(s):  
Venous Pressure ◽  
Venous Hypertension ◽  
Leg Ulcers ◽  
Vasomotor Response ◽  
Venous Ulceration ◽  
Doppler Flowmetry ◽  
Before And After ◽  
Venoactive Drugs ◽  
Positive Effect ◽  
Standard Techniques

A study of the microcirculation in patients with venous hyperterision and perimalleolar ulcers was used to evaluate the effects of medical treatment by Centellase 60. The evaluation of the resting flow and the observation of the venous response before and after treatment shows an interesting, positive effect of Centellase 60 in 25 patients with venous ulceration treated for 4 weeks. The decrease of the resting flow and the increased efficacy of the venous vasomotor response was both significant and associated with a significant decrease of the ulcerated areas. Laser-Doppler flowmetry was useful to demonstrate microcirculatory changes which were not revealed by standard techniques such as ambulatory venous pressure. It may be useful to reveal variations in venous hypertension produced by other treatments such as elastic compression or ‘venoactive’ drugs.

scholarly journals Assessment of the use of Unna boot in the treatment of chronic venous leg ulcers in adults: systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032091
Author(s):  
Thalita Paranhos ◽  
Caroline S B Paiva ◽  
Fernanda C I Cardoso ◽  
Priscila P Apolinário ◽  
Flavia Figueiredo Azevedo ◽  
...  
Keyword(s):  
Systematic Review ◽  
New York ◽  
Cochrane Library ◽  
Leg Ulcers ◽  
Venous Flow ◽  
Cross Sectional ◽  
Venous Leg Ulcers ◽  
The Us ◽  
Registration Number ◽  
Review Protocol

IntroductionChronic venous insufficiency (CVI) is an anomaly of the normal functioning of the venous system caused by valvular incompetence with or without the obstruction of venous flow. This condition can affect either or both of the superficial and the deep venous systems. Venous dysfunction can even result in congenital or acquired disorders, and its complications include venous leg ulcers (VLUs). The objective of this systematic review is to determine the effectiveness of Unna boot in the treatment of wound healing of VLU by assessing the quality of the available evidence.Methods and analysisA literature search in PubMed, CINAHL, Scopus, Web of Science, Cochrane Library, BVS/BIREME, Embase, ProQuest, BDTD, Thesis and Dissertation Catalog, Sao Paulo Research Foundation/Thesis and dissertation, OPEN THESIS, A service of the US National Institute of Health, Center for Reviews and Dissemination-University of New York and SciElo published in the last 10 years, the period from January 1999 to March 2019. The review will include primary studies (original), and Controlled Trials or Observational studies (cross-sectional, case–control or longitudinal studies) with VLU. The exclusion will include leg ulceration due to different causes, such as pressure, arterial, diabetic or mixed-aetiology leg ulcers. Data synthesis will be performed using a narrative summary and quantitative analysis.Ethics and disseminationThis systematic review does not require approval by the ethics committee, as individual patient data will not be collected. Dissemination of findings will be through publications in peer-reviewed journals and/or via conference presentations.PROSPERO registration numberCRD42019127947

Healing rates following venous surgery for chronic venous leg ulcers in an independent specialist vein unit

2013 ◽  
Vol 28 (3) ◽  
pp. 132-139 ◽  
Author(s):  
C A Thomas ◽  
J M Holdstock ◽  
C C Harrison ◽  
B A Price ◽  
M S Whiteley
Keyword(s):  
Retrospective Study ◽  
Clinical Improvement ◽  
Ulcer Healing ◽  
Surgical Intervention ◽  
Response Rate ◽  
Significant Proportion ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Venous Surgery

Objectives This is a retrospective study over 12 years reporting the healing rates of leg ulcers at a specialist vein unit. All patients presented with active chronic venous leg ulcers (clinical, aetiological, anatomical and pathological elements [CEAP]: C6) and had previously been advised elsewhere that their ulcers were amenable to conservative measures only. Method Seventy-two patients (84 limbs) were treated between March 1999 and June 2011. Patients were contacted in August 2011 by questionnaire and telephone. Of 72 patients, two were deceased and two had moved location at follow-up, so were not contactable. Fifty patients replied and 18 did not (response rate 74%), representing a mean follow-up time of 3.1 years. Results Ulcer healing occurred in 85% (44 of 52 limbs) of which 52% (27) limbs were no longer confined to compression. Clinical improvement was achieved in 98% of limbs. Conclusions This study shows that a significant proportion of ulcers currently managed conservatively can be healed by surgical intervention.

scholarly journals Cost-Effective Management of Venous Ulcer

1970 ◽  
Vol 2 (2) ◽  
pp. 136-141
Author(s):  
SAN Alam ◽  
AHM Bashar ◽  
KM Alam ◽  
MN Sabah ◽  
GMM Hossain ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Ulcer Healing ◽  
Great Saphenous Vein ◽  
Cost Effective ◽  
Venous Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Group I ◽  
Venous Surgery ◽  
Group Ii

Background: Venous disorders are very common. About 20% of the population suffer from varicose veins, 2% have skin changes which may precede venous ulceration. Venous ulcers represent a common and debilitating condition associated with significant financial loss for the patients as well as the society. Treatment options for these patients are costly and time consuming. In this study we tried to find out cost-effective measures for treating this group of patients.Method: To evaluate the effectiveness and safety of superficial and perforating leg venous surgery along with pharmacotherapy 66 patients with chronic venous leg ulcers are prospectively studied. After proper history taking and clinical examination all patients underwent venous duplex ultrasonography. Patients were divided into two groups. Group I (n=30) includes patients undergoing saphenofemoral ligation and stripping of the great saphenous vein (GSV). In group II (n=36) patients underwent saphenofemoral and incompetent leg perforator ligation along with stripping of the GSV. Conservative measures, local ulcer care and pharmacotherapy were common in both groups.Result: Postoperative complications, total hospital stay and ulcer healing were studied. Ulcer healing was earlier in group II. Remarkable complications were similar in both the groups.Conclusion: For effective and economic care of venous leg ulcers, combination of standard surgical procedures including incompetent perforator and saphenofemoral ligation with great saphenous vein stripping and standard physio-pharmacotherapeutic care is essential. This combined modality of treatment is highly effective in early and complete ulcer healing in patients suffering from venous ulcers.Keywords: Venous ulcer: Saphenofemoral ligation: Perforator ligation.  DOI: 10.3329/cardio.v2i2.6629Cardiovasc. j. 2010; 2(2) : 136-141

scholarly journals Venous collapse regulates intracranial pressure in upright body positions

2018 ◽  
Vol 314 (3) ◽  
pp. R377-R385 ◽  
Author(s):  
P. Holmlund ◽  
A. Eklund ◽  
L.-O. D. Koskinen ◽  
E. Johansson ◽  
N. Sundström ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Healthy Volunteers ◽  
Venous Pressure ◽  
Venous System ◽  
Explanatory Model ◽  
Central Venous ◽  
Jugular Veins ◽  
Cross Sectional ◽  
Recent Interest ◽  
Postural Changes

Recent interest in intracranial pressure (ICP) in the upright posture has revealed that the mechanisms regulating postural changes in ICP are not fully understood. We have suggested an explanatory model where the postural changes in ICP depend on well-established hydrostatic effects in the venous system and where these effects are interrupted by collapse of the internal jugular veins (IJVs) in more upright positions. The aim of this study was to investigate this relationship by simultaneous invasive measurements of ICP, venous pressure, and IJV collapse in healthy volunteers. ICP (monitored via the lumbar route), central venous pressure (peripherally inserted central catheter line), and IJV cross-sectional area (ultrasound) were measured in 11 healthy volunteers (47 ± 10 yr, mean ± SD) in 7 positions, from supine to sitting (0–69°). Venous pressure and anatomical distances were used to predict ICP in accordance with the explanatory model, and IJV area was used to assess IJV collapse. The hypothesis was tested by comparing measured ICP with predicted ICP. Our model accurately described the general behavior of the observed postural ICP changes (mean difference, −0.03 ± 2.7 mmHg). No difference was found between predicted and measured ICP for any tilt angle ( P values, 0.65–0.94). The results support the hypothesis that postural ICP changes are governed by hydrostatic effects in the venous system and IJV collapse. This improved understanding of postural ICP regulation may have important implications for the development of better treatments for neurological and neurosurgical conditions affecting ICP.

Treatment of venous leg ulcers with sulodexide

Phlebologie ◽  
2003 ◽  
Vol 32 (05) ◽  
pp. 115-120 ◽  
Author(s):  
A. Franek ◽  
H. Koziolek ◽  
M. Kucharzewski
Keyword(s):  
Pharmacological Treatment ◽  
Healing Process ◽  
Leg Ulcers ◽  
Venous Ulceration ◽  
Venous Leg Ulcers ◽  
Group I ◽  
Group Ii

SummaryAim: The study of the influence of sulodexide in the treatment of venous leg ulcers. Patients and method: 44 patients with chronic venous ulceration were randomly divided into two groups. Group I: 21 patients (ulceration area: 12.7-18.9 cm2), Group II: 23 patients (ulceration size: 12.1-20.3 cm2). Both groups were treated by using Unna’s boot. This dressing was changed every seven days until the ulcer had healed. Additionally, the patients in group II received the systemic pharmacological treatment with sulodexide. Results: After 7 weeks of treatment ulcers of seven patients (35%) from group I had healed, and 3 weeks later the ulceration of two more patients had healed completely. After further 7 weeks the ulcers of 12 patients had healed completely. Whereas in group II after 7 weeks of treatment ulceration of 16 (70%, p <0.05) patient had healed completely and after further 3 weeks the ulcers of the remaining 7 patients had healed, too. Conclusion: The use of sulodexide in patients with chronic venous leg ulcers accelerates the healing process.

scholarly journals Effects of intermittent pneumatic compression on femoral vein peak venous velocity during active ankle exercise

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199810
Author(s):  
Kenta Sakai ◽  
Naonobu Takahira ◽  
Kouji Tsuda ◽  
Akihiko Akamine
Keyword(s):  
Femoral Vein ◽  
Bed Rest ◽  
Intermittent Pneumatic Compression ◽  
Postoperative Rehabilitation ◽  
Venous Flow ◽  
Compression Phase ◽  
Superficial Femoral Vein ◽  
Inpatient Ward ◽  
Vein Thrombosis ◽  
Strong Compression

Introduction: The risk of developing deep vein thrombosis (DVT) is high even after the period of bed rest following major general surgery including total joint arthroplasty (TJA). Mobile intermittent pneumatic compression (IPC) devices allow the application of IPC during postoperative exercise. Although ambulation included ankle movement, no reports have been made regarding the effects of IPC during exercise, including active ankle exercise (AAE), on venous flow. This study was performed to examine whether using a mobile IPC device can effectively augment the AAE-induced increase in peak velocity (PV). Methods: PV was measured by Doppler ultrasonography in the superficial femoral vein at rest, during AAE alone, during IPC alone, and during AAE with IPC in 20 healthy subjects in the sitting position. PV in AAE with IPC was measured with a mobile IPC device during AAE in the strong compression phase. AAE was interrupted from the end of the strong compression phase to minimize lower limb fatigue. Results: AAE with IPC (76.2 cm/s [95%CI, 69.0–83.4]) resulted in a significant increase in PV compared to either AAE or IPC alone (47.1 cm/s [95%CI, 38.7–55.6], p < 0.001 and 48.1 cm/s [95%CI, 43.7–52.4], p < 0.001, respectively). Discussion: Reduced calf muscle pump activity due to the decline in ambulation ability reduced venous flow. Therefore, use of a mobile IPC device during postoperative rehabilitation in hospital and activity including self-training in an inpatient ward may promote venous flow compared to postoperative exercise without IPC. Conclusion: Use of a mobile IPC device significantly increased the PV during AAE, and simultaneous AAE with IPC could be useful evidence for the prevention of DVT in clinical settings, including after TJA.

Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis

2021 ◽  
pp. 1358863X2110036
Author(s):  
Seshadri Raju ◽  
William Walker ◽  
Chandler Noel ◽  
Riley Kuykendall ◽  
Thomas Powell ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Venous Pressure ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Systematic Bias ◽  
Cross Sectional ◽  
External Iliac Vein ◽  
The Difference ◽  
Vein Stenosis ◽  
Linear Regressions

Minimum iliac vein caliber necessary to maintain normal peripheral venous pressure can be derived by the Poiseuille equation. Duplex was compared to intravascular ultrasound (IVUS) in the assessment of iliac vein stenosis in this single center retrospective study. Parallel IVUS and duplex caliber data for common iliac vein (CIV) and external iliac vein (EIV) in 382 limbs were separately compared. One or both segments were stenotic by IVUS criteria in 213 limbs. Neither segment was stenotic by IVUS in 22 limbs. Bland–Altman analyses and Passing–Bablok linear regressions were used. Duplex calibers were dimensionally smaller than corresponding IVUS images of CIV and EIV segments in Bland–Altman comparison by a mean of 54 mm2 and 34 mm2, respectively. Passing–Bablok regression suggested the difference was due to a systematic bias and not proportional. Duplex yields a smaller cross-sectional image of CIV and EIV compared to IVUS. Duplex is not a reliable diagnostic test for iliac vein stenosis.

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