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Pihlaja T, Vanttila LM, Ohtonen P, Pokela M. Factors associated with delayed venous ulcer healing after endovenous intervention for superficial venous insufficiency. J Vasc Surg Venous Lymphat Disord 2022; 10:1238-1244. [PMID: 35961629 DOI: 10.1016/j.jvsv.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This retrospective trial analyzed the effect of predetermined variables on venous ulcer healing after endovenous ablation of insufficient veins. METHODS A total of 259 patients presenting 273 venous leg ulcers (VLUs) at Oulu University Hospital vascular outpatient clinic between January 2010 and December 2020 were included in the study. In addition to compression therapy, all patients received endovenous ablation (endothermal ablation and/or foam sclerotherapy) to promote venous healing. The hazard ratio (HR) for an ulcer to heal was analyzed in univariate analysis of predetermined factors, including age, sex, recurrent venous ulcer, presence of great saphenous vein or small saphenous vein reflux, persistent superficial vein reflux after ablation, recanalization in treated segments, ulcer age, body mass index >35 kg/m2, history of deep vein thrombosis, history of erysipelas, ability to move, smoking, hypertension, atrial fibrillation, coronary artery disease, diabetes mellitus, and cardiac insufficiency. Logistic regression was used in a multivariate analysis to identify independent risk factors for ulcer healing. RESULTS In the univariate analysis, healing was negatively associated with persistent superficial vein reflux after ablation (HR, 0.117; 95% confidence interval [CI], 0.088-0.354), recanalization in treated segments (HR, 0.161; 95% CI, 0.060-0.433), nonambulatory patient (HR, 0.322; 95% CI, 0.130-0.800), history of deep vein thrombosis (HR, 0.518; 95% CI, 0.294-0.910), and presence of small saphenous vein reflux (HR, 0.565; 95% CI, 0.384-0.830). Independent risk factors included persistent superficial vein reflux after ablation (HR, 0.123; 95% CI, 0.0051-0.295). All the patients in the persistent superficial vein reflux group had their VLUs eventually healed after further endovenous treatment. CONCLUSIONS When treating patients with VLUs, persistent superficial vein reflux after ablation was negatively associated with ulcer healing. After additional endovenous ablative treatment, ulcers with persistent reflux eventually healed.
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Affiliation(s)
- Toni Pihlaja
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland.
| | | | - Pasi Ohtonen
- Division of operative care, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Matti Pokela
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
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Garavello A, Gilardi S, Fiamma P, Toti V, Tozzi M, Fransvea P. Deep Venous Thrombosis and Ulcers of Lower Limbs: Ultrasound Findings in 156 Patients. Int J Angiol 2022; 31:113-119. [PMID: 35833180 PMCID: PMC9272312 DOI: 10.1055/s-0042-1743408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Venous ulcers (VUs) of lower limbs affect 1% of Western population. In most cases, ultrasounds show only superficial venous insufficiency (SVI), but a deep venous insufficiency (DVI) may also be present without a history of deep vein thrombosis (DVT). To assess SVI and DVI in DVT-positive and DVT-negative patients with VU, a retrospective cohort of 123 patients entered the study (50 male and 73 female, minimum age 29 years and maximum age 90 years, and mean 70.6 years). In 56 patients (45.5%), ulcer was on the right leg, in 52 (42.3%) on the left leg, and in 15 patients (12.2%), ulcer was bilateral, resulting in a total number of 138 limbs in the study. Sixty-six patients suffered DVT, while in 72 anamnesis was negative. Color duplex ultrasound was performed on both limbs, which revealed insufficiencies of superficial and/or deep veins in 18 limbs which had not been affected by an ulcer or a previous DVT. So the study was on 156 limbs. SVI were substantially overlapping in two groups ( p -value = 0.593), while combined SVI and DVI was 72.5% in DVT positive limbs ( p -value = 0.001). In 70% of cases with a femoral vein insufficiency ( p -value = 0.036) or popliteal vein insufficiency (PVI) ( p -value 0,003), a DVT history was present. Of 18 limbs, although not affected by ulcer or previous DVT, eight were positive for DVI (two femoral veins and six popliteal veins). In the patient with VU, the history of DVT is a strong predictor of DVI insufficiency. In DVT-positive patients with ulcer, the number of "combined superficial and deep insufficiencies" appears to be particularly significant and surgical treatment must take this into account. A previous DVT has a low impact on great and small saphenous insufficiencies in ulcer patients; these were substantially overlapping in DVT-positive and DVT-negative patients. The 18 limbs with DVI and SVI without ulcer and DVT history were unexpected result. We think these patients must have a close follow-up to avoid the onset of a VU.
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Affiliation(s)
- Alberto Garavello
- UOC Chirurgia d'Urgenza e del trauma fondazione Policlinico Universitario A.Gemelli IRCCS - Roma
| | - Stefania Gilardi
- Centro Per la Terapia Dell'ulcera Venosa e Arteriosa, Ospedale San Filippo Neri -ASL RM1, Roma, Italy
| | - Paola Fiamma
- Centro Per la Terapia Dell'ulcera Venosa e Arteriosa, Ospedale San Filippo Neri -ASL RM1, Roma, Italy
| | - Valentina Toti
- Centro Per la Terapia Dell'ulcera Venosa e Arteriosa, Ospedale San Filippo Neri -ASL RM1, Roma, Italy
| | | | - Pietro Fransvea
- Dipartimento di Chirurgia D'urgenza, Policlinico Agostino Gemelli, Roma, Italy
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Meulendijks A, de Vries F, van Dooren A, Schuurmans M, Neumann H. A systematic review on risk factors in developing a first‐time Venous Leg Ulcer. J Eur Acad Dermatol Venereol 2019; 33:1241-1248. [DOI: 10.1111/jdv.15343] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- A.M. Meulendijks
- Julius Center of Health Care Sciences Nursing Science University Medical Centre Utrecht Utrecht The Netherlands
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - F.M.C. de Vries
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
- Raboud University Nijmegen The Netherlands
| | - A.A. van Dooren
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - M.J. Schuurmans
- Julius Center of Health Care Sciences Nursing Science University Medical Centre Utrecht Utrecht The Netherlands
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - H.A.M. Neumann
- Department of Dermatology Erasmus Medical Center Rotterdam The Netherlands
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Finlayson KJ, Parker CN, Miller C, Gibb M, Kapp S, Ogrin R, Anderson J, Coleman K, Smith D, Edwards HE. Predicting the likelihood of venous leg ulcer recurrence: The diagnostic accuracy of a newly developed risk assessment tool. Int Wound J 2018. [PMID: 29536629 DOI: 10.1111/iwj.12911] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to validate a newly developed tool for predicting the risk of recurrence within 12 months of a venous leg ulcer healing. Performance of the tool to predict recurrence within a 12-month period was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Multi-site retrospective and prospective longitudinal studies were undertaken to validate a risk assessment tool for the recurrence of venous leg ulcers within 12 months. In the retrospective study (n = 250), 55% of venous leg ulcers recurred within 12 months, and the risk assessment total score had excellent discrimination and goodness of fit with an AUC of 0.83 (95% CI, 0.76-0.90, P < .001). The prospective study (n = 143) observed that 50.4% (n = 63) of venous leg ulcers recurred within 12 months of healing. Participants were classified using the risk assessment tool as being at low risk (28%), moderate risk (59%), and high risk (13%); the proportion of wounds recurring at 12 months was 15%, 61%, and 67% for each group, respectively. Validation results indicated good discrimination and goodness of fit, with an AUC of 0.73 (95% CI, 0.64-0.82, P < .001). Validation of this risk assessment tool for the recurrence of venous leg ulcers provides clinicians with a resource to identify high-risk patients and to guide decisions on adjunctive, tailored interventions to address the specific risk factors to decrease the risk of recurrence.
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Affiliation(s)
- Kathleen J Finlayson
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Wound Management Innovation Cooperative Research Centre, Queensland, Australia
| | - Christina N Parker
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Wound Management Innovation Cooperative Research Centre, Queensland, Australia
| | - Charne Miller
- La Trobe University, Melbourne, Victoria, Australia.,Alfred Health Clinical School, The Alfred Centre, Prahran, Victoria 3181, Australia
| | - Michelle Gibb
- Wound Management Innovation Cooperative Research Centre, Queensland, Australia
| | - Suzanne Kapp
- School of Health Sciences, Department of Nursing, The University of Melbourne, Carlton, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
| | - Rajna Ogrin
- Bolton Clarke, St Kilda, Victoria, Australia
| | | | - Kerrie Coleman
- Multidisciplinary Skin Integrity Service, Royal Brisbane & Women's Hospital, St. Herston, Queensland, Australia
| | - Dianne Smith
- Multidisciplinary Skin Integrity Service, Royal Brisbane & Women's Hospital, St. Herston, Queensland, Australia
| | - Helen E Edwards
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Wound Management Innovation Cooperative Research Centre, Queensland, Australia
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Editor's Choice – Mid-term Outcomes of Endovenous Laser Ablation in Patients with Active and Healed Venous Ulcers: A Follow-up Study. Eur J Vasc Endovasc Surg 2017; 53:710-716. [DOI: 10.1016/j.ejvs.2017.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/24/2017] [Indexed: 11/22/2022]
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Abstract
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.
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Martis G, Laczik R. The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis. Phlebology 2016; 31:753-768. [PMID: 27257053 DOI: 10.1177/0268355516652011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim Analysis of the radical removing of the dermatosclerotic tissues and ulcer(s) with perforator veins dissection as well as local wound and standard compression treatment of CEAP C5/6 stage in a prospective comparative cohort study. Primary endpoint is to compare the results of the one-year follow-up regarding quality of life, vein clinical severity score, and ulcer healing process. Secondary endpoint is the precise presentation of the surgical technique. Tertiary endpoint is to demonstrate the photo-documented results of the postoperative wound treatment protocol. Method Clinical and statistical comparison of radical surgery versus solely wound care and compression in a cohort of 15 patients in each group (Groups 1, 2). In Group 1, radical removing of the dermatosclerotic pannicule and leg ulcer, perforator vein dissection, great saphenous vein, or small saphenous vein was performed. Quality of life , pain intensity, vein clinical severity score and patients' load capacity were compared. The tissue oxygen saturation changes were monitored via near infra-red spectroscopy. Results Both groups were statistically comparable. Wound healing in the operated group was 100% versus 60% in the second one, the difference was significant, p = 0.006. The quality of life: 45.33 versus 36.8, p < 0.001, intensity of leg restless and pain: 2.28 versus 5.3, p < 0.001, changes of vein clinical severity score: 5.27 versus 20.93, p < 0.001, changes of tO2sat: 19.00 versus 6.07 in the upper third of the leg p < 0.001, proved significantly better in group 1 compared to 2. Load capacity was significantly better in group 1 than 2 at the end of the study. The average wound healing time was 113 days in group 1. Conclusion The radical surgery provides significantly better results, considering quality of life, vein clinical severity score, load capacity than the conservative treatment in this study.
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Affiliation(s)
- Gábor Martis
- 1 Department of Vascular Surgery, Clinical and Health Science Centre, Institute of Surgery, University of Debrecen, Debrecen, Hungary
| | - Renáta Laczik
- 2 Department of Angiology, Clinical and Health Science Centre, Institute of Medicine, University of Debrecen, Debrecen, Hungary
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Amato B, Compagna R, Amato M, Butrico L, Fugetto F, Chibireva MD, Barbetta A, Cannistrà M, de Franciscis S, Serra R. The role of adult tissue-derived stem cells in chronic leg ulcers: a systematic review focused on tissue regeneration medicine. Int Wound J 2015; 13:1289-1298. [PMID: 26399452 DOI: 10.1111/iwj.12499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/10/2015] [Accepted: 08/16/2015] [Indexed: 12/12/2022] Open
Abstract
Wound healing is an articulated process that can be impaired in different steps in chronic wounds. Chronic leg ulcers are a special type of non-healing wounds that represent an important cause of morbidity and public cost in western countries. Because of their common recurrence after conventional managements and increasing prevalence due to an ageing population, newer approaches are needed. Over the last decade, the research has been focused on innovative treatment strategies, including stem-cell-based therapies. After the initial interest in embryonic pluripotent cells, several different types of adult stem cells have been studied because of ethical issues. Specific types of adult stem cells have shown a high potentiality in tissue healing, in both in vitro and in vivo studies. Aim of this review is to clearly report the newest insights on tissue regeneration medicine, with particular regard for chronic leg ulcers.
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Affiliation(s)
- Bruno Amato
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Rita Compagna
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maurizio Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Lucia Butrico
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Francesco Fugetto
- School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Mariia D Chibireva
- School of Medicine, Kazan State Medical University, Kazan, Tatarstan Republic, Russian Federation
| | - Andrea Barbetta
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Marco Cannistrà
- Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Stefano de Franciscis
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
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