Venous intervention in chronic venous ulcer treatment and recurrence avoidance

Phlebologie ◽  
2016 ◽  
Vol 45 (03) ◽  
pp. 135-139
Author(s):  
N. Morrison
Keyword(s):  
Venous Insufficiency ◽  
Ulcer Patient ◽  
Venous Ulcer ◽  
Venous Intervention ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Pump Failure ◽  
Venous Ulcers ◽  
Superficial Venous Insufficiency

SummaryIn this brief overview I will progress from superficial venous intervention for venous leg ulcers (VLU) to perforator intervention and finally to deep venous intervention. But first there are a number of concepts that must be accepted. We know that 70 % of patients with leg ulcers have a venous component (1), and in at least 40 % of those patients, ulcers will be caused by superficial venous insufficiency alone or in combination with perforator incompetence (2). Such patients will likely benefit from treatment of their superficial venous disease.One of the most important but often overlooked factors in venous ulcers is calf pump failure. Simka has reported that 45 % of patients with venous ulcers have calf pump failure (3).Thorough duplex evaluation of the venous leg ulcer patient is paramount for accurate diagnosis, the differentiation between arterial and venous components (purely arterial, venous, or mixed etiology), and the obstructive and/or incompetent nature and location of venous lesions. In obstructive venous lesions the degree of obstruction as well as how proximal the lesion extends must be known. For venous insufficiency the location (deep and/or superficial venous system) and the extent (segmental or axial) will help determine how much the incompetence contributes to the overall ulcer condition, and what lesions can be safely treated.

Seasonal variations in the onset and healing rates of venous leg ulcers

2010 ◽  
Vol 25 (1) ◽  
pp. 29-34 ◽  
Author(s):  
M Simka
Keyword(s):  
Time Series ◽  
Immune System ◽  
Seasonal Variations ◽  
Venous Insufficiency ◽  
Venous Ulcer ◽  
Leg Ulcers ◽  
Case Histories ◽  
Retrospective Survey ◽  
Venous Ulcers ◽  
Strong Seasonality

Objectives As many vascular pathologies exhibit circannual fluctuation, the aim of this study was to assess the chronobiological features of venous ulcers. Methods Based on a retrospective survey of the case histories of 391 venous ulcer patients, the rates of ulcer onset and healing in each month were analysed statistically; a time series was constructed to evaluate the seasonality. Results There was a significantly higher frequency of ulcer onset during the warmer part of the year (April–October), and onset showed strong seasonality. Healing rates were also unequally and statistically significantly distributed throughout the year: ulcers that appeared or that were treated with specialized treatment in the winter or summer healed slower in comparison to ulcers that began in the spring or autumn. Conclusions Venous ulcers exhibit circannual fluctuations in their onset and healing rates. Hypothetically, in addition to exacerbation of chronic venous insufficiency, seasonal variations in immune system activity might potentially be responsible for this phenomenon.

Subcutaneous fasciotomy and eradication of superficial venous reflux for chronic and recurrent venous ulcers: mid-term results

2011 ◽  
Vol 26 (5) ◽  
pp. 197-202 ◽  
Author(s):  
J T Christenson ◽  
C Prins ◽  
G Gemayel
Keyword(s):  
Ulcer Healing ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Subcutaneous Tissue ◽  
Skin Grafting ◽  
Venous Ulcer ◽  
Venous Disease ◽  
Ulcer Recurrence ◽  
Venous Ulcers ◽  
Mid Term Results

Objective Increased intramuscular and subcutaneous tissue pressures are often found in patients with severe chronic venous insufficiency venous ulcer disease. Additional subcutaneous para-tibial fasciotomy promotes early ulcer healing. This study evaluates the mid-term effect of eradication of superficial reflux with additional fasciotomy in patients with increased tissue pressures. Method Between January 2006 and June 2009, 58 patients underwent fasciotomy. Tissue pressures (intramuscular and subcutaneous) were measured. Sixty-nine limbs with 91 venous ulcers were treated. Mean duration of the venous ulcer was 3.4 years. Underlying disease was post-thrombotic syndrome (PT) in 19 patients (33%, 24 limbs, 27 ulcers) and non-post-thrombotic (non-PT) severe chronic venous insufficiency in 39 (67%, 45 limbs, 64 ulcers). All patients were C6 at the time of surgery. Preoperative tissue pressures were 23.5 ± 6.1 mmHg (intramuscularly) and 9.8 ± 3.2 mmHg (subcutaneously). Results Ninety ulcers (99%) healed postoperatively (42 with and 48 without skin grafting). Tissue pressures significantly decreased following surgery and remained low at three months postoperatively. Ten ulcers in six patients recurred six to 20 months postoperatively (11%), resulting in 86.4 actuarial freedom from venous ulcer recurrence at three years following surgery. Four patients (1 non-PT and 3 PT) had re-fasciotomy; all healed initially but two ulcers (2 patients, PT) recurred at 11 and 12 months. Those patients underwent re-fasciotomy, one healed and one recurred six months later. Conclusion Eradication of superficial reflux with additional subcutaneous fasciotomy for chronic and recurrent venous ulcer improves ulcer healing or success of skin grafting. Mid-term results are excellent particularly in patients with non-PT disease. Recurrence is more frequently seen in patients with PT syndrome. In patients with ulcer recurrence and high tissue pressures, re-fasciotomy can be helpful to promote healing, particularly in patients with primary venous disease.

Superficial Venous Disease

2018 ◽  
pp. 287-298
Author(s):  
Ronald S. Winokur ◽  
Geraldine Abbey-Mensah ◽  
Neil M. Khilnani
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Venous Ulcers ◽  
Patient Morbidity ◽  
And Performance ◽  
Superficial Venous Insufficiency

Superficial venous insufficiency (SVI) is an extremely common condition affecting up to 39% of Americans, which results in significant patient morbidity and high healthcare costs (up to $3 billion per year for treatment). In addition to patients with asymptomatic spider veins and painful varicose veins, over 2 million adults have advanced chronic venous disease (CVD), and at least 20,000 individuals develop new venous ulcers each year. Patients suffering from venous insufficiency can benefit greatly from office-based, minimally invasive treatments. Successful treatment depends on understanding of superficial venous anatomy and pathophysiology, how to conduct a targeted history and physical exam, and performance and interpretation of Duplex ultrasound (DUS), as well as knowledge and application of the available treatment options.

Venous Leg Ulcer Healing: A Randomized Prospective Study of Long-Stretch versus Short-Stretch Compression Bandages

1998 ◽  
Vol 13 (2) ◽  
pp. 59-63 ◽  
Author(s):  
L. Danielsen ◽  
S. M. Madsen ◽  
L. Henriksen
Keyword(s):  
Ulcer Healing ◽  
Venous Ulcer ◽  
Positive Influence ◽  
Compression Bandage ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Venous Leg Ulcers ◽  
Area Reduction ◽  
Compression Bandages ◽  
Table Analysis

Objective: To compare the efficacy of a long-stretch bandage with that of a short-stretch compression bandage. Design: Prospective evaluation of healing of venous leg ulcers in blindly randomized groups of patients. Setting: Bispebjerg Hospital, Copenhagen, Denmark. Patients: Forty-three patients with venous leg ulcers were included. Forty legs in 40 patients were evaluated at 1 month (34 patients), 6 months (32 patients) or 12 months (27 patients). Interventions: Both types of bandage were used at a width of 10 cm and applied using the same spiral bandaging technique. Main outcome measures: Ulcer healing and ulcer area reduction. Results: Healed ulcers after 1 month were observed in 27% of the long-stretch group and in 5% of the short-stretch group ( p = 0.15); after 6 months the corresponding figures were 50% and 36% ( p = 0.49) and after 12 months 71% and 30% ( p = 0.06). Using life-table analysis the predicted healing rate in the long-stretch group after 12 months was 81% and for the short-stretch group 31% ( p = 0.03). The mean of relative ulcer areas at 1 month was 0.45 for the long-stretch group and 0.72 for the short-stretch group ( p = 0.07), at 6 months the corresponding figures were 0.81 and 0.60 ( p = 0.25) and at 12 months 0.25 and 0.95 ( p = 0.01). Conclusions: The present study appears to indicate a Positive influence of the elasticity of a compression bandage on venous ulcer healing.

Persistent venous leg ulcers complicated by linear morphea: a case report

2020 ◽  
Vol 29 (Sup9) ◽  
pp. S14-S20
Author(s):  
Georgeanne Cornell ◽  
Martin Kade Hardy ◽  
Jonathon Wilson
Keyword(s):  
Venous Insufficiency ◽  
Wound Care ◽  
Venous Stasis ◽  
Term Therapy ◽  
Leg Ulcers ◽  
Common Condition ◽  
Venous Ulcers ◽  
History Of ◽  
Long Term Therapy

Soft tissue ulceration resulting from chronic venous insufficiency is a common condition that requires standardised long-term therapy, which has been thoroughly established. We report a patient with a five-year history of persistent venous stasis ulcers despite treatment consistent with traditional wound care. Resolution of the ulcers began only upon deviation from conventional therapy. This report considers non-standard treatments in patients with venous ulcers that do not progress.

Procedural training for the management of superficial venous insufficiency: A survey of Rouleaux Club members

2019 ◽  
Vol 35 (4) ◽  
pp. 247-254
Author(s):  
Lewis Meecham ◽  
Sandip Nandhra ◽  
Isaac K Nyamekye ◽  
Keyword(s):  
Vascular Surgery ◽  
Open Surgery ◽  
Venous Insufficiency ◽  
Potential Problem ◽  
Venous Intervention ◽  
Duplex Ultrasonography ◽  
Formal Training ◽  
Procedural Training ◽  
New Curriculum ◽  
Superficial Venous Insufficiency

Introduction In 2012, the Rouleaux Club published their survey claiming large deficits in venous training. Since then vascular surgery has become its own specialty with a dedicated section of the curriculum for superficial venous intervention. The aim of this study was to assess whether the introduction of the new curriculum has improved current Rouleaux Club members training in superficial venous intervention. Method A trainee designed survey was developed and distributed to UK vascular surgery trainees in summer 2017. Results We received 55 (41.0%) responses. Training in endovenous procedures was available to 100% of trainees, and open surgery was only available to 43.2% of trainees; 86.5% of centres used endovenous procedures as the default intervention Only 75.7% of respondents were timetabled for dedicated superficial venous intervention lists; 72.7% have not received any formal training in duplex ultrasonography. Higher self-reported procedural competence was associated with greater numbers of procedures rather than training grade seniority. Conclusion It seems that despite a separate curriculum there are still self-reported trainee deficits in competence and skills. Low respondent levels (41%) should be considered but there is a potential problem for future venous practice.

Frequency of Isolated Superficial Venous Incompetence in Patients with Venous Ulcers as Measured by Ambulatory Strain-Gauge Plethysmography

1995 ◽  
Vol 10 (2) ◽  
pp. 65-68 ◽  
Author(s):  
C. Hansson ◽  
J. Holm
Keyword(s):  
Strain Gauge ◽  
Screening Method ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Pressure Measurements ◽  
Venous Leg Ulcer ◽  
Venous Ulceration ◽  
Venous Leg Ulcers ◽  
Strain Gauge Plethysmography ◽  
Venous Ulcers

Objective: Identification of isolated superficial venous incompetence (SVI) in patients with clinically diagnosed venous leg ulcers using a computerized strain-gauge plethysmograph. Design: Ambulatory leg ulcer patients were assessed as to the clinical diagnosis. Diagnoses other than venous ulceration were excluded. Setting: Department of Dermatology, Sahlgrenska Hospital, Göteborg, Sweden. Patients: One hundred and fourteen patients (133 legs) with venous leg ulcers were investigated. Main outcome measures: All patients were also investigated by measuring systolic ankle and arm pressure measurements. The ankle/arm (AI) was below 0.9 in 22 of the 133 ulcerated legs. Results: Of the 111 ulcerated legs with an AI>0.9, 10% had an isolated SVI. Conclusions: Isolated SVI is an important cause of venous leg ulcer development. Strain-gauge plethysmography is an inexpensive screening method, and is easy to use. Further examination with the more exact, but also more expensive and time-consuming, colour duplex should be performed in selected cases.

Microcirculatory changes in venous disease

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 73-78 ◽  
Author(s):  
L C Huisman ◽  
C Den Bakker ◽  
C H A Wittens
Keyword(s):  
Wound Care ◽  
Daily Practice ◽  
Venous Ulcer ◽  
Venous Hypertension ◽  
Laser Speckle ◽  
Venous Disease ◽  
Laser Speckle Imaging ◽  
Speckle Imaging ◽  
Venous Ulcers ◽  
Before And After

Objective: The aim of this study was to investigate the feasibility to measure microcirculatory blood flow changes in patients with venous ulcers, by using the laser speckle imaging. Methods: Nine patients with a leg ulcer were measured with the laser speckle imager in a sitting position before and after mimicking venous hypertension, with the legs raised, by applying a blood pressure cuff and inflating it to 60 mmHg. Results: The results were inconclusive, due to the fact that a lot of practical problems interfered with the measurements, e.g. movement artefacts and inadequate wound visualisation. Conclusion: The additional value of laser speckle imaging in daily practice for wound care still remains an important question for further research. A reliable, reproducible microcirculation measurement in venous ulcers might predict venous ulcer healing and recurrence and therefore would be a valuable diagnostic tool in daily practice.

scholarly journals Translation and cross-cultural adaptation of the Venous Leg Ulcer Self Efficacy Tool for use in a Swiss-French setting

2020 ◽  
Vol 21 (Issue 1 Volume 21, 2020) ◽  
pp. 7-10
Author(s):  
Mathieu Turcotte ◽  
Monika Buehrer Skinner ◽  
Sebastian Probst
Keyword(s):  
Cultural Adaptation ◽  
Chronic Venous Insufficiency ◽  
Self Efficacy ◽  
Venous Insufficiency ◽  
Cross Cultural ◽  
Leg Ulcer ◽  
Leg Ulcers ◽  
Venous Leg Ulcer ◽  
Cross Cultural Adaptation ◽  
Venous Leg Ulcers

Venous leg ulcers are lesions between the ankle joint and the knee caused by chronic venous insufficiency. The Venous Leg Ulcer Self Efficacy Tool (VeLUSET) was developed to measure self-care and self-efficacy in Englishspeaking persons with venous leg ulcers. This study describes the translation and cross-cultural adaptation of the original version of the VeLUSET from English into Swiss French.

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