scholarly journals TREATMENT OF TROPHIC ULCERS IN PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY USING PHOTHOTHERAPY AND HETEROTRANSPLANT

2021 ◽  
pp. 85-89
Author(s):  
V. A. Prasol ◽  
Yu. V. Ivanova ◽  
L. M. Al Kanash ◽  
S. A. Beresnyev ◽  
O. A. Golovina
Keyword(s):  
Growth Factor ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Wound Closure ◽  
Combined Treatment ◽  
Lower Leg ◽  
Platelet Derived Growth Factor ◽  
Perforating Veins ◽  
Combined Use ◽  
Hospitalization Period

Summary. Purpose. The improvement of the treatment effect of patients with a decompensated form of the chronic venous insufficiency. Reduction of the reatment period in a hospital by application of the complex treatment. Materials and methods. The work was based on the studies of 24 patients who had trophic ulcers on the lower leg. All patients have undergone combined treatment, including scleroobliteration of perforating veins, phototherapy, platelet-derived growth factor, the use of wound closure with a heterograft. Results and discussion. The combined use of phototherapy and platelet-derived growth factor has significantly reduced the duration of all phases of the wound process. The ultrasound-controlled scleroobliteration has helped to remove a pathological reflux in the insolvent tibial perforators. The studies have shown that the use of phototherapy in the treatment of trophic ulcers with the application of the heterograft has contributed to the rapid cleansing of wounds, accelerating the appearance of granulations and epithelialization, has reduced the need for antibacterial therapy and is an alternative to autodermoplasty. Conclusions. The use of the offered technique allows to reach optimum restoration conditions of the affected fabrics trophism, leads to the decrease in the number of complications and reduces the hospitalization period.

scholarly journals In situ hemodynamics of perforating veins in chronic venous insufficiency

2001 ◽  
Vol 33 (4) ◽  
pp. 773-782 ◽  
Author(s):  
Konstantinos T. Delis ◽  
Marc Husmann ◽  
Evi Kalodiki ◽  
John H. Wolfe ◽  
Andrew N. Nicolaides
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Perforating Veins

Surgical Treatment of the Superficial and Perforating Veins

2000 ◽  
Vol 15 (3-4) ◽  
pp. 131-136 ◽  
Author(s):  
P. Gloviczki
Keyword(s):  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
High Ligation ◽  
Ulcer Recurrence ◽  
Perforating Veins ◽  
Post Thrombotic Syndrome ◽  
Venous Ulcers ◽  
Ulcer Surgery

Objective: To review the techniques and results of surgical treatment of the superficial and perforating veins in patients with chronic venous insufficiency. Methods: The current techniques used at the Mayo Clinic for treatment of simple varicose veins and venous ulcers are presented. Results of subfascial endoscopic perforator vein surgery (SEPS) are discussed and data from large centres are tabulated. Results are compared with those reported following non-operative management. Synthesis: High ligation and invagination stripping of the incompetent segment of the saphenous vein, with stab avulsion of branch varicosities, is the optimal surgical technique to ablate superficial venous incompetence. SEPS is safer than open perforator vein ligation and is the technique of choice to interrupt incompetent perforating veins. A review of 12 series on SEPS, that included 361 limbs, found an ulcer recurrence rate of 10% in those 211 patients who underwent ablation of superficial reflux together with SEPS. One hundred and fifty limbs had SEPS alone, without saphenous stripping: ulcer recurrence in this group at a mean of 23 months was 12%. Results in primary valvular incompetence were significantly better than in post-thrombotic syndrome. Conclusions: Ablation of superficial reflux remains the main surgical treatment of all forms of chronic venous insufficiency. SEPS is safe and effective to interrupt medial calf perforators and results in rapid ulcer healing and low recurrence in patients with primary valvular incompetence. The treatment of post-thrombotic syndrome remains a challenge. Results of the North American Venous Ulcer Surgery (NAVUS) trial, a prospective, randomised, multicentre study, will be required to provide level 1 evidence of the effectiveness of surgical treatment over medical therapy in the treatment of venous ulcers.

Chronic Venous Insufficiency and the Therapeutic Effects of Daflon 500 mg

Angiology ◽  
2005 ◽  
Vol 56 (6_suppl) ◽  
pp. S21-S24 ◽  
Author(s):  
John J. Bergan
Keyword(s):  
Shear Stress ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Vena Cava ◽  
Venous Hypertension ◽  
Therapeutic Effects ◽  
Inflammatory Cascade ◽  
Perforating Veins ◽  
Days Of Therapy

Chronic venous insufficiency is linked to venous hypertension and forces of shear stress on the endothelium. Venous hypertension depends upon two forces: the weight of a column of blood from the right atrium transmitted through the valveless vena cava and iliac veins to the femoral vein, and pressure generated by contracting skeletal muscles of the leg transmitted through failed perforating veins. When valve failure occurs in superficial axial veins and perforating veins, the venous pressure in the veins and venules of the skin and subcutaneous tissue is raised. The skin changes in chronic venous insufficiency are directly related to the severity of the venous hypertension. Also, pathologic changes in the valves are linked to venous hypertension and leukocyte infiltration and activation. It is hypothesized that acute venous pressure elevations cause a shift in the venous hemodynamics with changes in wall shear stress. This initiates the inflammatory cascade. Daflon 500 mg ameliorates the effects of chronic inflammation. In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. Because venous insufficiency is linked to venous hypertension and an inflammatory reaction, it appears that Daflon 500 mg 2 tablets daily shows a great potential for accomplishing blockade of the inflammatory cascade.

scholarly journals Nuclear Factor I-C Links Platelet-Derived Growth Factor and Transforming Growth Factor β1 Signaling to Skin Wound Healing Progression

2009 ◽  
Vol 29 (22) ◽  
pp. 6006-6017 ◽  
Author(s):  
Genta Plasari ◽  
Alessandra Calabrese ◽  
Yves Dusserre ◽  
Richard M. Gronostajski ◽  
Alan Mcnair ◽  
...  
Keyword(s):  
Gene Expression ◽  
Growth Factor ◽  
Wound Closure ◽  
Transforming Growth Factor ◽  
Platelet Derived Growth Factor ◽  
Nuclear Factor ◽  
Matrix Deposition ◽  
Factor I ◽  
Nuclear Factor I

ABSTRACT Transforming growth factor β (TGF-β) and platelet-derived growth factor A (PDGFΑ) play a central role in tissue morphogenesis and repair, but their interplay remain poorly understood. The nuclear factor I C (NFI-C) transcription factor has been implicated in TGF-β signaling, extracellular matrix deposition, and skin appendage pathologies, but a potential role in skin morphogenesis or healing had not been assessed. To evaluate this possibility, we performed a global gene expression analysis in NFI-C−/− and wild-type embryonic primary murine fibroblasts. This indicated that NFI-C acts mostly to repress gene expression in response to TGF-β1. Misregulated genes were prominently overrepresented by regulators of connective tissue inflammation and repair. In vivo skin healing revealed a faster inflammatory stage and wound closure in NFI-C−/− mice. Expression of PDGFA and PDGF-receptor alpha were increased in wounds of NFI-C−/− mice, explaining the early recruitment of macrophages and fibroblasts. Differentiation of fibroblasts to contractile myofibroblasts was also elevated, providing a rationale for faster wound closure. Taken together with the role of TGF-β in myofibroblast differentiation, our results imply a central role of NFI-C in the interplay of the two signaling pathways and in regulation of the progression of tissue regeneration.

A Reassessment of the Role of Perforating Veins in Chronic Venous Insufficiency

1990 ◽  
Vol 5 (2) ◽  
pp. 85-94 ◽  
Author(s):  
G.M. McMullin ◽  
H.J. Scott ◽  
P.D. Coleridge Smith ◽  
J.H. Scurr
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Reverse Flow ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Perforating Veins ◽  
Clinically Normal

Ambulatory venous hypertension is closely associated with the signs and symptoms of venous disease. It has been shown that reverse flow of blood in the superficial and deep veins is responsible. The pressure derangement caused by incompetence of perforating veins has not been established. The present study documents the pressure disturbances caused by incompetence in each of the three compartments of the venous system, the deep, the superficial and the perforating veins. In total 90 limbs of 49 patients with chronic venous insufficiency were examined and classified by duplex scanning and ascending venography. Ambulatory venous pressure measurements were performed on all 90 limbs and a venous sufficiency index (VSI) for each limb calculated from the percentage drop in pressure and refilling time. VSI was lowest in the group with deep vein incompetence (median 0.9, range 0–36.9), intermediate in the groups with superficial vein incompetence (median 7.6, range 0.4–59) and with incompetent perforating veins (median 14.6, range 0.4–35.7) and highest in the group with normal veins (median 41.7, range 3.5–87.5). The association of symptoms and VSI was also examined. The lower the VSI the more severe were the clinical symptoms and all ulcerated limbs had a VSI < 20. However a number of clinically normal limbs were also found to have low values of VSI.

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