Venous Insufficiency Ulcers [keywords]
- [Venous ulcer]. [English Abstract, Journal Article]
- Wien Med Wochenschr 2016 Jun; 166(9-10):287-92.
Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms.
- Long-term results of the monocusp valve formation in the common femoral vein in patients presenting with avalvular deep veins of the lower extremities. [JOURNAL ARTICLE]
- Int Angiol 2016 Jun 30.
Aim of the study was to evaluate the long-term results of the monocusp valve formation in the common femoral vein (CFV) in patients presenting with avalvular deep veins (ADV) of the lower extremities.A total of 36 patients (24 women and 12 men) at the age varying from 37 to 58 years old were given surgical treatment during the period from 2008 to 2014. 6 patients presented with congenital ADV while in the remaining 30 ADV was a consequence of the postthrombotic lesion in the valves with the complete recanalization and manifested deep venous axial reflux. In terms of CEAP clinical classification, the patients were categorized into the following groups: C4b (n=11), C5 (n=18), C6 (n=7). All the patients underwent duplex ultrasound (DUS) examination. 12 patients were additionally examined by venography. Kistner grade IV reflux was diagnosed in all the patients. 28 patients had undergone surgical interventions on superficial and perforating veins before. The severe (C4b-C6) forms of chronic venous disease with manifested axial reflux in deep veins were regarded as an indication for surgery in the patients refractory to traditional treatment. The method described by J.Opie et al. was employed to construct the monocusp venous valve in the CFV.The long-term results of the treatment were evaluated in 26 patients followed up during the period from 18 to 48 (mean 29.5±8.2) months. Cumulative clinical success rate at four years was 76.5%. Freedom from ulcer reccurence at four years was 83.4% (C6 patients). Cumulative competence rate of the neovalve was accomplished in 70.6%. The evaluation in two years based on the VCSS revealed the reduction in the severity of the manifestations of chronic venous insufficiency (P<0.01). The quality of life was improved, its index decreased from 60.6±18.7 to 40.7±12.8 (P<0.05). The circumference of the narrowest segment of the tibia decreased from 271.1±4.7 to 256.8±5.7 мм (P<0.05).Formation of the monocusp valve in CFV makes it possible to eliminate pathological blood reflux from the inferior vena cava to deep veins of the lower extremities that is known to be one of the main factors in the appearance and progression of chronic venous insufficiency (CVI). The high effectiveness of this operation is confirmed by the well apparent clinical improvement in the state of the affected lower extremity and the quality of life of the patients.
- Management of venous ulcers: State of the art. [JOURNAL ARTICLE]
- Int J Surg 2016 Jun 21.
Venous ulceration is a complex and serious problem that affects 1-2% of the global elderly population (>65 years), and its incidence is constantly increasing. The population group with higher risk of development of venous ulceration is the elderly. These lesions have a significant negative impact on patients' quality of life. Our aim was to analyze the state of the art, starting with the medical literature review. The evidence supports that managing chronic wounds with a multidisciplinary wound care team significantly increases wound healing and reduces the severity of wound-associated pain and the required daily wound treatments compared with persons who are not managed by such a team.
- [Epidemiology of chronic venous diseases]. [English Abstract, Journal Article]
- Wien Med Wochenschr 2016 Jun; 166(9-10):260-3.
Overview of the recent knowledge in epidemiology of chronic venous diseases.Systematic search and discussion of recent studies concerning epidemiology of chronic venous diseases.The more recent epidemiologic studies of venous diseases in which the CEAP classification was used showed a prevalence of 60-70 % CEAP clinical class C0 and C1, app. 25 % for C2 and C3 and up to 5 % for C4 to C6 with skin changes or venous ulcers. The incidence of varicose veins is app. 2 % per year.Chronic venous diseases like varicose veins and chronic venous insufficiency belong to the most frequent diseases in our adult population.
- [QUALITY OF LIFE AND PSYCHOLOGICAL ASPECTS IN PATIENTS WITH CHRONIC LEG ULCER]. [English Abstract, Journal Article]
- Acta Med Croatica 2016 Mar; 70(1):61-3.
Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is "A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity". Based on this definition, quality of life in relation to health may be defined as "the functional effect of an illness and it's consequent therapy upon a patient, as perceived by the patient". The domains that contribute to this effect are physical, psychological and social functioning. The patient's own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases, including chronic wounds, are depression, anxiety, aggression and frustration. Psychological factors may not only be a consequence of delayed healing, but may also impact on wound healing. Anxiety and depression have direct influences on endocrine and immune function. About the impact of disease on quality of life and individuals' perceptions of illness, there are questionnaires and methods to analyze this, but the challenge is to move from a focus on wound management to understanding the specific needs of each individual within the context of their life.
- [CHRONIC WOUND--A NEW ETIOPATHOGENETIC STATE AND MODERN THERAPEUTIC APPROACH]. [English Abstract, Journal Article]
- Acta Med Croatica 2016 Mar; 70(1):5-17.
Lower leg ulcer is the most common form of ulceration of lower extremities. The prevalence of leg ulcer varies among studies from 0.1% to 0.6%. During the last decade, new concepts on the inflammatory phase in chronic ulcer have been discovered, such as the importance of metalloproteinases, growth factor, irregular muscular function, vascular insufficiency and presence of biofilm in the ulcer that prevents healing. There are several hypotheses to explain the pathophysiological steps, referring to popliteal venous hypertension. Currently, the treatment of leg ulcer relies on due knowledge of ulcer pathophysiology and making an accurate diagnosis. Today, modern supportive dressings improve the patient's quality of life; however, their targeted application according to the protocol and indications is required. A new method of efficient wound biofim exclusion today is the application of hydrofiber dressings containing a combination of silver ions and two disinfectants because they influence the exclusion and prevention of new biofilm formation in the ulcer.
- The Impact of Race on Advanced Chronic Venous Insufficiency. [Journal Article]
- Ann Vasc Surg 2016 Jul.:152-6.
The study aimed to determine the association between race and patient variables, hospital covariates, and outcomes in patients presenting with advanced chronic venous insufficiency.The National Inpatient Sample was queried to identify all Caucasian and African-American patients with a primary International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for venous stasis with ulceration (454.0), inflammation (454.1), or complications (454.2) from 1998 to 2011. CEAP scores were correlated with ICD-9 diagnosis. Demographics, CEAP classification, management, cost of care, length of stay (LOS), and inpatient mortality were compared between races. Statistical analysis was via descriptive statistics, Student's t-test, and the Fisher's exact test. Trend analysis was completed using the Mann-Kendall test.A total of 20,648 patients were identified of which 85% were Caucasian and 15% were African-American. Debridement procedures had the highest costs at $6,096 followed by skin grafting at $4,089. There was an overall decrease in the number of ulcer debridements, vein stripping, and sclerotherapy procedures between 1998 and 2011 (P < 0.05) for both groups. However, African-American patients had significantly more ulcer debridements than their Caucasian counterparts.African-American patients with a primary diagnosis of venous stasis present with more advanced venous disease at a younger age compared with their Caucasian counterparts. This is associated with increased ulcer debridement, deep vein thrombosis rates and hospital charges in the African-American cohort. There are no differences in sclerotherapy or skin grafting procedures, LOS or inpatient mortality between races.
- Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum. [Journal Article]
- J Wound Ostomy Continence Nurs 2016 Jul-Aug; 43(4):347-64.
Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity.
- Challenging passivity in venous leg ulcer care - the ABC model of management. [JOURNAL ARTICLE]
- Int Wound J 2016 May 5.
The under-utilisation of compression for venous leg ulcer (VLU) management translates into lost opportunities to heal wounds, improve patients' quality of life and maximise health care system efficiency. Although compression therapy is considered gold standard according to clinical guidelines, lack of clinician knowledge, unclear referral pathways, local unavailability of compression and patient unwillingness to receive compression, amongst other reasons, mean many candidates for compression do not receive appropriate treatment. This article presents a solution in the form of the 'ABC model of VLU management, a simplified approach that challenges passivity in the current approach to VLU treatment and supports wider adoption of appropriate compression therapy systems.
- Popliteal vein external banding at the valve-free segment to treat severe chronic venous insufficiency. [JOURNAL ARTICLE]
- J Vasc Surg 2016 Apr 27.
Axial deep venous reflux causes skin changes or ulcers in patients with chronic venous insufficiency (CVI). The study aimed to review the results of correcting axial deep venous reflux using the novel valve-free popliteal vein external banding (PVEB) technique in patients with severe CVI.We retrospectively reviewed 1252 patients (1252 limbs) who underwent PVEB for treatment of severe CVI from 2000 to 2015. The number and position of popliteal vein valves (PVVs) and gastrocnemius vein entries were analyzed. Preprocedural and postprocedural intraluminal pressure and other hemodynamic parameters were measured and compared. Synchronous skin grafting was used for large ulcers. The healing time and ulcer and symptom recurrence rate were analyzed. Long-term Venous Clinical Severity Score was compared.One pair of PVV leaflets, gastrocnemius vein entries proximal to the PVV, and PVV located in the distal-third popliteal vein segment were confirmed in 87.38% of cases in the venographic study. A total of 1252 patients underwent PVEB, and 1041 patients were followed up (mean follow-up, 55.12 months; range, 9-183 months). In the short term, limb swelling and pain were relieved in 1187 patients (94.81%) without use of compression therapy. The reflux time and reflux volume were significantly reduced (P < .001). All the ulcers were healed in an average of 18 days (95% confidence interval, 16.68-19.32). In the long term, the ulcer recurrence rate was 3.63%. The Venous Clinical Severity Score was significantly reduced (P < .001).PVEB, which neither opens the vein wall nor relies on the existing vein valves, can promote venous return, improve hemodynamic status, and heal venous ulcer in <2 months, with low complication and symptom recurrence rates.