Nonhealing Venous Ulcers and Chronic Venous Outflow Obstruction

2015 ◽  
Vol 105 (6) ◽  
pp. 541-549
Author(s):  
Jonathan Labovitz ◽  
Paul Gagne ◽  
Keith Penera ◽  
Sandra Wainwright
Keyword(s):  
Ulcer Healing ◽  
Iliac Vein ◽  
Venous Ulcer ◽  
Venous Disease ◽  
Ulcer Recurrence ◽  
Outflow Obstruction ◽  
Venous Compression ◽  
Venous Ulcers ◽  
Venous Compression Syndromes ◽  
Compression Syndromes

The etiology of chronic venous insufficiency is typically neglected or misunderstood when treating lower-extremity edema and venous ulcerations. Despite the high prevalence of venous compression syndromes, it is rarely considered when treating venous ulcers and unresolved venous disease. We report a case of bilateral iliac vein outflow obstruction that prohibited venous ulcer healing until properly treated. This case highlights the importance of properly identifying and treating venous compression syndromes to enhance ulcer healing and decrease the risk of venous ulcer recurrence.

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.

Venous Compression Syndromes

2017 ◽  
Vol 51 (3) ◽  
pp. 155-168 ◽  
Author(s):  
Joseph M. White ◽  
Anthony J. Comerota
Keyword(s):  
Left Renal Vein ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Diagnostic Methods ◽  
Common Iliac Vein ◽  
Management Options ◽  
Venous Compression ◽  
Extrinsic Compression ◽  
Venous Compression Syndromes ◽  
Compression Syndromes

Venous compression syndromes occur due to extrinsic compression causing complications of venous hypertension or venous thrombosis. This review focuses on 4 venous compression syndromes involving the left common iliac vein, subclavian vein, left renal vein, and popliteal vein. Clinical presentation, diagnostic methods, and management options are reviewed. When properly diagnosed and treated, long-term consequences can be avoided.

Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort

2022 ◽  
pp. 153473462110659
Author(s):  
Michele Neves Brajão Rocha ◽  
Carol Viviana Serna Gonzalez ◽  
Eline Lima Borges ◽  
Vera Lúcia Conceição de Gouveia Santos ◽  
Soraia Assad Nasbine Rabeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Outpatient Clinic ◽  
Onset Time ◽  
Venous Ulcer ◽  
High Recurrence Rate ◽  
Ulcer Recurrence ◽  
Clinical Approach ◽  
Historical Cohort ◽  
Venous Ulcers

The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.

scholarly journals Iliac Vein Angioplasty Augments Venous Ulcer Healing in Patients who have Standard Compression Therapy and Perforator Closure

2013 ◽  
Vol 58 (4) ◽  
pp. 1146
Author(s):  
Albeir Y. Mousa ◽  
Mike Broce ◽  
Shadi Abu-Halimah ◽  
Saadi Alhalbouni ◽  
Betro Sadek ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Compression Therapy ◽  
Iliac Vein ◽  
Venous Ulcer

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.

Assessment of a New One-Layer Adhesive Bandaging Method in Maintaining Prolonged Limb Compression and Effects on Venous Ulcer Healing

1992 ◽  
Vol 7 (2) ◽  
pp. 59-63 ◽  
Author(s):  
J. P. Travers ◽  
K. L. Dalziel ◽  
G. S. Makin
Keyword(s):  
Ulcer Healing ◽  
Varicose Veins ◽  
Venous Ulcer ◽  
Control Group ◽  
Acrylic Adhesive ◽  
Venous Ulcers ◽  
Hospital Patients ◽  
The One ◽  
Experimental Group ◽  
Adhesive Bandage

Objective: To evaluate the effective duration of compression of acrylic adhesive bandaging compared to non-adhesive bandaging and to compare rate of venous ulcer healing using one layer adhesive bandaging as compared to standard three layer bandaging. Design: The first trial involved patients who had undergone bilateral operations for varicose veins. Adhesive acrylate bandage was applied to the experimental limb and non-adhesive crepe to the control limb. The second trial involved patients with venous ulcers randomly allocated to two groups. The experimental group used the one layer acrylic adhesive bandage whilst the control was treated by the three layer bandage technique (zinc oxide paste bandage followed by a non-adhesive compression bandage and tubular overlay). Setting: Hospital patients in the first trial and clinic patients in the second. Patients, participants: First trial, 11 patients with bilateral varicose veins of which 10 completed. Second trial, 15 patients in the experimental group and 12 patients in the control group all of which completed. Results: Non-adhesive bandaging lost effective compression after 24 hours. Acrylic adhesive bandage maintained effective compression after 1 week. The rate of venous ulcer healing was similar between the one layer adhesive bandage group and three layer group. One layer adhesive bandaging took only one quarter of the time to apply (p<0.01%). Conclusions: Adhesive bandaging produced more effective sustained compression than non-adhesive crepe. Adhesive bandaging was as effective as the currently used three layer bandaging technique in healing venous ulcers and was quicker to apply.

scholarly journals Imaging of venous compression syndromes

2016 ◽  
Vol 6 (6) ◽  
pp. 519-532 ◽  
Author(s):  
Evan J. Zucker ◽  
Suvranu Ganguli ◽  
Brian B. Ghoshhajra ◽  
Rajiv Gupta ◽  
Anand M. Prabhakar
Keyword(s):  
Venous Compression ◽  
Venous Compression Syndromes ◽  
Compression Syndromes

scholarly journals Venous compression syndromes: clinical features, imaging findings and management

2013 ◽  
Vol 86 (1030) ◽  
pp. 20130284 ◽  
Author(s):  
S R Butros ◽  
R Liu ◽  
G R Oliveira ◽  
S Ganguli ◽  
S Kalva
Keyword(s):  
Clinical Features ◽  
Imaging Findings ◽  
Venous Compression ◽  
Venous Compression Syndromes ◽  
Compression Syndromes

DEep VEin Lesion OPtimisation (DEVELOP) Trial Study protocol for a randomised, assessor-blinded feasibility study of iliac vein intervention for venous leg ulcers

2019 ◽  
Author(s):  
Thomas M Aherne ◽  
C. Keohane ◽  
M. Mullins ◽  
S. A. Black ◽  
T.Y. Tang ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Feasibility Study ◽  
Ulcer Healing ◽  
Lower Limb ◽  
Randomised Trial ◽  
Compression Therapy ◽  
Iliac Vein ◽  
Ulcer Recurrence ◽  
Recurrence Rates ◽  
Venous Ulceration

Abstract Background: Venous leg ulceration is a widespread, debilitating pathology with high recurrence rates. Conservative treatment using graduated compression dressings may be associated with unacceptable ulcer recurrence rates. Early superficial venous ablation encourages ulcer healing and reduces recurrence. However, many of this cohort display concomitant ilio-caval stenosis, which further contributes to lower limb venous hypertension and ulceration. An approach which combines early superficial venous ablation with early treatment of ilio-caval stenotic disease may significantly improve ulcer healing and recurrence rates. We question whether early iliac vein interrogation with intravascular ultrasound (IVUS), stenting of significant occlusive disease plus superficial venous ablation, in patients with active venous leg ulceration, will produce superior ulcer healing to standard therapy. Methods: This is a prospective, multi-centre, randomised controlled, feasibility study recruiting patients with lower limb venous ulceration and Great Saphenous incompetence. Patients will be randomised to undergo either truncal ablation and compression therapy or truncal ablation, simultaneous iliac interrogation with intravascular ultrasound and stenting of significant (>50%) iliac vein lesions plus compression therapy. The primary endpoints will be ulcer healing and procedural safety. Secondary endpoints include time to healing, quality of life and clinical scores, ulcer recurrence rates and rates of post-thrombotic syndrome. Follow up will be over a five-year period. This feasibility study is designed to include 60 patients. Should it be practicable a total of 594 patients would be required to adequately power the study to definitively address ulcer-healing rates. Discussion: This study will be the first randomised trial to examine the role iliac interrogation and intervention in conjunction with standard operative therapy in the management of venous ulceration related to Great Saphenous incompetence. Ethical Committee Reference: C.A. 2111 Galway Clinical Research Ethics Comittee. Registration: Clinical Trials.gov registration NCT03640689 , Registered 21/08/2018, https://clinicaltrials.gov/ct2/show/NCT03640689. Keywords: Venous ulcer, endovenous, deep venous intervention, iliac vein, intra-vascular ultrasound, great saphenous incompetence.

Sign in / Sign up

Export Citation Format

Share Document