Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Venous Insufficiency Ulcers [keywords]
- Chronic venous insufficiency. [Journal Article]
- Circulation 2014 Jul 22; 130(4):333-46.
- Leg ulcers in antiphospholipid syndrome secondary to systemic lupus erythematosus treated with intravenous immunoglobulin. [Journal Article]
- J Dermatol Case Rep 2014 Jun 30; 8(2):38-41.
Despite encouraging reports on the efficacy of intravenous immunoglobulin (IVIg) in antiphospholipid syndrome, the clinical value of this treatment is not well established, and most of the data are based on case reports and small series of patients.We describe the significant improvement of leg ulcers with IVIg in a 61-year-old female, with diabetes mellitus, venous peripherical insufficiency and secondary antiphospholipid syndrome to systemic lupus erythematosus.This case illustrates a rare cause of leg ulcers and documents that IVIg may be an effective adjuvant treatment in the management of selected patients with antiphospholipid syndrome when conventional strategies using subcutaneous heparin and low-dose aspirin are insufficient.
- Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience. [JOURNAL ARTICLE]
- Lasers Med Sci 2014 Jul 4.
Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95 %. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.
- [Venous ulcer--patience and consequence are demanded]. [Journal Article]
- MMW Fortschr Med 2014 May 28; 156(10):68-9.
- Early activation of fibroblasts during PDT treatment in leg ulcers. [JOURNAL ARTICLE]
- G Ital Dermatol Venereol 2014 Jun 13.
This pilot study was aimed to assess the variations of some microscopical parameters in skin ulcers, caused by chronic venous insufficiency of the lower extremities (chronic leg ulcers), in 15 patients refractory to previous conventional treatments during Photodynamic therapy (PDT).Samples of control, wounded and PDT treated skin were taken and analyzed by immunohistochemistry. RESULTS:The cellular infiltrate, as well as the thickness of epidermis, vascularization, mast cell and fibroblast numbers, were increased in chronic wounds as compared to healthy skin. After completion of PDT, fibroblasts appeared further increased in number. Mast cells, closely clustered with fibroblasts, also showed an increase in their numbers, degranulation index and expression of basic fibroblast growth factor.The present findings support a primary role of fibroblasts in the wound healing process upon PDT treatment, given their early and intense reaction to injury. Mast cells seem to play an accessory yet important role, on the basis of their number and degranulation index variations and expression of basic FGF. In addition, the clustering of mast cells with fibroblasts around blood vessels suggest that these cells may stimulate angiogenesis and, in parallel, fibroblasts to secrete extracellular matrix during PDT therapy.
- [Treatment of venous trophic ulcers, using echoscleroobliteration of perforant veins]. [English Abstract, Journal Article]
- Klin Khir 2014 Feb; (2):5-7.
In 36 patients, suffering trophic ulcers on a chronic venous insufficiency background in a decompensated stage (C6 in accordance to CEAP), echoscleroobliteration of perforant veins, using a "foam-form" method in accordance to Tessari, was performed. In 29 patients postrombophlebitic syndrome in incomplete recanalization stage was diagnosed, in 7 recurrence of varicose disease of the lower extremities. In all the patients during echoscleroobliteration there was possible to obliterate the insufficient perforant veins, in 3 patients two perforant veins were obliterated in each of them. In a one week a pathological blood flow along perforant veins, in accordance to data of ultrasound duplex scanning, was absent. This effect lasted during 6 mo in 29 (80.6%) patients. In 25 (69.4%) patients a trophic ulcers healing was achieved in 1 - 3 mo. In a one year in 30 (83.3%) patients a stable obliteration was noted, in 3 (8.3%) - partial recanalization, in 3 (8.3%) - complete recanalization of perforant veins.
- [Update on current care guidelines: chronic leg ulcers]. [English Abstract, Journal Article]
- Duodecim 2014; 130(9):942-3.
Chronic leg ulcer is a common disorder affecting 1.3-3.6 % of people at some time of their life. The etiology of the ulcer can often be identified through careful clinical examination. The majority of leg ulcers are caused by venous or arterial insufficiency. The target of ulcer treatment should always be directed to the cause of the ulcer. Correction of the circulatory disorder is essential for ulcer healing. Since the probability of ulcer healing reduces as the ulcer becomes chronic, effective treatment should be initiated immediately. Skin grafting should be considered for ulcers > 20 cm2 and > 6 months duration.
- Clinical Examination and Treatment of a Leg Ulcer Caused by a Stingray Puncture. [JOURNAL ARTICLE]
- Int J Low Extrem Wounds 2014 May 30.
The most frequent causes of leg ulcers include venous incompetency (superficial and deep), arterial insufficiency, trauma, vasculitis, and neoplasm. Leg ulcers from injury by stingrays are quite rare. In this case report, we describe a leg ulcer caused by a stingray sting complicated by infection, which healed completely without surgery. In addition, since there few cases in the literature describing such traumas, we performed a comprehensive review of the literature. Important is the fact that the wound healing was complete without resorting to surgery, but only with a correct targeted antibiotic therapy and the use of a collagenase, which has the particularity of having hyaluronic acid as a component.
- Histological difference between pulsed wave laser and continuous wave laser in endovenous laser ablation. [JOURNAL ARTICLE]
- Phlebology 2014 May 30.
Endovenous laser ablation to saphenous veins has been popular as a minimally invasive treatment for chronic venous insufficiency. However, adverse effects after endovenous laser ablation using continuous wave laser still remain. Pulsed wave with enough short pulse duration and sufficiently long thermal relaxation time may avoid the excess energy delivery, which leads to the perforation of the vein wall.(1) Free radiation: Laser is radiated in blood for 10 s. (2) Endovenous laser ablation: Veins were filled with blood and placed in saline. Endovenous laser ablations were performed.(1) There were clots on the fiber tips with continuous wave laser while no clots with pulsed wave laser. (2) In 980-nm continuous wave, four of 15 specimens had ulcers and 11 of 15 had perforation. In 1470-nm continuous wave with 120 J/cm of linear endovenous energy density, two of three presented ulcers and one of three showed perforation. In 1470-nm continuous wave with 60 J/cm of linear endovenous energy density, two of four had ulcers and two of four had perforation. In 1320-nm pulsed wave, there were neither ulcers nor perforation in the specimens.While endovenous laser ablation using continuous wave results in perforation in many cases, pulsed wave does not lead to perforation.
- Elevated Levels of Coagulation Factor VIII in Patients With Venous Leg Ulcers. [JOURNAL ARTICLE]
- Int J Low Extrem Wounds 2014 May 25.
Chronic venous disease affects millions of people around the world. Venous valvular incompetencies and venous reflux, often a result of outflow obstruction are important contributors to venous disease. The prevalence of thrombophilia is increased in patients with chronic venous insufficiency (CVI). The recognition of underlying thrombophilia particularly in young patients opens new avenues in the management and prevention plan. We emphasize on the consideration of workup for coagulopathy, especially factor VIII deficiency in young patients with venous disease. We report 3 patients with chronic leg ulcers and high levels of FVIII:C activity in plasma and other associated thrombophilic factors. We highlight the need to get a workup done for thrombophilia in young patients with recurrent and chronic leg ulcers related to venous insufficiency or livedoid vasculopathy. Further studies with larger sample sizes are required to define the definite indications for the thrombophilia workups.