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Tan MK, Bootun R, Wang R, Onida S, Lane T, Davies AH. A Systematic Review of Anatomical Reflux Patterns in Primary Chronic Venous Disease. J Vasc Surg Venous Lymphat Disord 2024:101946. [PMID: 39025298 DOI: 10.1016/j.jvsv.2024.101946] [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: 05/06/2024] [Revised: 06/27/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Patients with chronic venous disease can present with different underlying haemodynamic abnormalities affecting the deep, superficial and perforator veins. This review explores the relationship between reflux patterns, extent of venous reflux and clinical manifestations of chronic venous disease. METHODS The Medline and EMBASE databases were systematically searched from 1946 to 1st April 2024. References of shortlisted papers were searched for relevant articles. Studies were included if they were in English language, included participants ≥16 years of age, documented reflux patterns in ≥2 of the following: deep, superficial and/or perforator systems, and related patterns to presentation or severity. Exclusion criteria included patients with isolated deep venous thrombosis, post-thrombotic syndrome or stenotic or obstructive disease. RESULTS 18 studies were identified (11,177 participants, range 55 to 3016). Meta-analysis showed significant odds ratios (OR) for C4-6 disease being associated with deep reflux (OR 2.41, 95% confidence interval (CI) 1.53-3.78) and perforator reflux (OR 3.37, 95% CI 2.16-5.27), but not superficial reflux (OR 2.11, 95% CI 0.87-5.14), versus C0-3 disease. Severe chronic venous disease (C4-6) was significantly associated with isolated deep, combined deep/superficial and combined superficial/perforator reflux. The highest risk of CVD progression (defined as de novo development of varicose veins and progression to greater CVD severity) was shown by two studies to be related to combined deep/superficial reflux. CONCLUSIONS While limited by the heterogenous nature of the studies, this review confirms that reflux pattern is a significant predictor of clinical class, and higher CEAP stages are associated with higher prevalence of superficial, deep and perforator reflux. Isolated deep and combined reflux also appear to predict the onset of leg ulceration. Future studies should relate reflux patterns to treatment outcomes, including recurrence risk. This could help inform health policies and management guidelines so that reflux patterns, in conjunction with other demographic and haemodynamic parameters, could be used to risk stratify patients and identify individuals that may benefit from earlier treatment.
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Affiliation(s)
- Matthew Kh Tan
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Roshan Bootun
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom; Cambridge Vascular Unit, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Roy Wang
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom; Cambridge Vascular Unit, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom.
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Cleman J, Xia K, Haider M, Nikooie R, Scierka L, Romain G, Attaran RR, Grimshaw A, Mena-Hurtado C, Smolderen KG. A state-of-the-art review of quality-of-life assessment in venous disease. J Vasc Surg Venous Lymphat Disord 2024; 12:101725. [PMID: 38128828 DOI: 10.1016/j.jvsv.2023.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Chronic venous disease is a common condition and has a significant impact on patients' health status. Validated patient-reported outcome measures (PROMs) used to assess health status are needed to measure health status. This state-of-the-art review summarizes the current validation evidence for disease-specific PROMs for chronic venous disease and provides a framework for their use in the clinical setting. METHODS A literature search in OVID Embase and Medline was conducted to identify relevant English-language studies of chronic venous disease that used disease-specific PROMs between January 1, 1993, and June 30, 2022. Abstracts and titles from identified studies were screened by four investigators, and full-text articles were subsequently screened for eligibility. Data on validation of disease-specific PROMs was abstracted from each included article. Classical test theory was used as a framework to examine a priori defined validation criteria for content validity, reliability (construct validity, internal reliability, and test-retest reliability), responsiveness, and expansion of the validation evidence base (use in randomized controlled trials and comparative effectiveness research, cultural or linguistic translations, predictive validity, or establishing the minimal clinically important difference threshold, defined as smallest amount an outcome or measure is perceived as a meaningful change to patients). The PROMs were categorized into three groups based on the manifestations of disease of the population for which they were developed. The overall validity of each PROM was assessed across three stages of validation including content validity (phase 1); construct validity, reliability, and responsiveness (phase 2); and expansion of the validation evidence base (phase 3). RESULTS Of 2338 unique studies screened, 112 studies (4.8%) met inclusion criteria. The eight disease-specific PROMs identified were categorized into three groups: (1) overall chronic venous disease (C1 to C6); (2) C1 to C4 disease; and (3) C5 to C6 disease. Assessed by group, the Chronic Venous Insufficiency Questionnaire met criteria for validation at all three phases for patients with C1 to C4 disease, and the Charing Cross Venous Ulcer Questionnaire met criteria for validation at all three phases for patients with C5 to C6 disease. There were no PROMs that met all criteria for validation for use in overall chronic venous disease (C1 to C6). CONCLUSIONS Of the eight PROMs assessed in this review, only two met prespecified criteria at each phase for validation. The Chronic Venous Insufficiency Questionnaire and Charing Cross Venous Ulcer Questionnaire should be considered for use in patients with chronic venous disease without venous ulcers and with venous ulcers, respectively.
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Affiliation(s)
- Jacob Cleman
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT
| | - Kevin Xia
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT
| | - Moosa Haider
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT
| | - Roozbeh Nikooie
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA
| | - Lindsey Scierka
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT
| | - Gaëlle Romain
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT
| | | | - Alyssa Grimshaw
- Department of Library and Information Science, Yale University, New Haven, CT
| | | | - Kim G Smolderen
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT.
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Nadasy GL, Patai BB, Molnar AA, Hetthessy JR, Tokes AM, Varady Z, Dornyei G. Vicious Circle With Venous Hypertension, Irregular Flow, Pathological Venous Wall Remodeling, and Valve Destruction in Chronic Venous Disease: A Review. Angiology 2024:33197241256680. [PMID: 38839285 DOI: 10.1177/00033197241256680] [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: 06/07/2024]
Abstract
Substantial advances occurred in phlebological practice in the last two decades. With the use of modern diagnostic equipment, the patients' venous hemodynamics can be examined in detail in everyday practice. Application of venous segments for arterial bypasses motivated studies on the effect of hemodynamic load on the venous wall. New animal models have been developed to study hemodynamic effects on the venous system. In vivo and in vitro studies revealed cellular phase transitions of venous endothelial, smooth muscle, and fibroblastic cells and changes in connective tissue composition, under hemodynamic load and at different locations of the chronically diseased venous system. This review is an attempt to integrate our knowledge from epidemiology, paleoanthropology and anthropology, clinical and experimental hemodynamic studies, histology, cell physiology, cell pathology, and molecular biology on the complex pathomechanism of this frequent disease. Our conclusion is that the disease is initiated by limited genetic adaptation of mankind not to bipedalism but to bipedalism in the unmoving standing or sitting position. In the course of the disease several pathologic vicious circles emerge, sustained venous hypertension inducing cellular phase transitions, chronic wall inflammation, apoptosis of cells, pathologic dilation, and valvular damage which, in turn, further aggravate the venous hypertension.
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Affiliation(s)
- Gyorgy L Nadasy
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | | | - Andrea A Molnar
- Department of Cardiology, Semmelweis University, Budapest, Hungary
| | | | - Anna-Maria Tokes
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | | | - Gabriella Dornyei
- Department of Morphology and Physiology, Health Science Faculty, Semmelweis University, Budapest, Hungary
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Ngatchou W, Barche B, Temgoua M, Metouguena SE, Jutcha I, Mvondo CM, Kamdem F, Dzudie A, Ndjoh S, Johne M, Metogo J, Ndom MS, Sango J, Ngo Yon C, Moulium S, Lade V, Kuaté LM, Menanga AP, Sobngwi E, Njock R, Blazquez SB, Ngowe Ngowe M. Prevalence, clinical presentation, and risk factors of chronic venous disease in Cameroon: A general population-based study. Phlebology 2024; 39:259-266. [PMID: 38158837 DOI: 10.1177/02683555231224111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa. METHODS We conducted the first population-based study over a period of 20 months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05. RESULTS A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02 years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8-22.9) and the prevalence of chronic venous insufficiency (C3-C6) was 7.02% (n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification (p < .001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04-1.56; p = .021), retired people (aOR: 46.9; 95% CI: 12.6-174.5; p < .001), hypertension (aOR: 289.5; 95%CI: 169.69-493.1; p < .001), diabetes (aOR: 2.19; 95% CI: 1.21-3.96; p = .009), obesity (aOR: 10.22; 95%CI: 7.67-13.62; p < .001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10-0.30; p < .001). CONCLUSION Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact.
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Affiliation(s)
- William Ngatchou
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Blaise Barche
- Clinical Research Education Networking and Consultancy, Douala, Cameroon
| | - Mazou Temgoua
- Department of Cardiology, Faculty of Medicine, University of Toulouse-Rangueil, Toulouse, France
| | - Serge Erwich Metouguena
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ivan Jutcha
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Charles Mve Mvondo
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Félicité Kamdem
- Department of Cardiology General Hospital, Douala, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Douala, Cameroon
- Department of Cardiology General Hospital, Douala, Cameroon
| | - Samuel Ndjoh
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marcel Johne
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Junette Metogo
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marie Solange Ndom
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Joseph Sango
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Carole Ngo Yon
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Sidick Moulium
- Department of Cardiology General Hospital, Douala, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Viche Lade
- Department of Cardiology General Hospital, Douala, Cameroon
| | - Liliane Mfeukeu Kuaté
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Alain Patrick Menanga
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Eugène Sobngwi
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Richard Njock
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Marcelin Ngowe Ngowe
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Guo B, Chen C, Li Y, Lv Q, Li X, Guo D, Shi Z, Fu W, Zhang WW. Principles of Optimal Antithrombotic Therapy for Iliac VEnous Stenting (POATIVES): A national expert-based Delphi consensus study. J Vasc Surg Venous Lymphat Disord 2024; 12:101739. [PMID: 38242205 DOI: 10.1016/j.jvsv.2023.101739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Management of antithrombotic therapy in patients undergoing venous stents has not yet reached consensus, and there are not any recommendations from published guidelines. We undertook a Delphi consensus from Chinese experts to develop recommendations regarding the preferred antithrombotic therapy in patients following venous stenting. METHODS The phase 1 questionnaire was comprised of three clinical scenarios of venous stenting for non-thrombotic iliac vein lesions (NIVL), acute deep vein thrombosis (DVT), and post-thrombotic syndrome (PTS) and was sent to venous practitioners across China. In phase 2, the results of phase 1 were distributed to a panel of experts for evaluation along with a questionnaire encompassing a series of statements produced during phase 1. A modified Delphi method was used to reach consensus on recommendations through two rounds of surveys. RESULTS The phase 1 questionnaire was completed by 283 respondents. In phase 2, an expert panel consisting of 28 vascular surgeons and interventional radiologists was assembled and voted 17 statements relating to antithrombotic management after venous stenting for NIVL (4 statements), DVT (6 statements), and PTS (7 statements). The majority of the statements about the antithrombotic agent selection received a high consensus strength. CONCLUSIONS Based on the national Delphi consensus of Chinese experts regarding antithrombotic therapy following iliac venous stenting in three common scenarios, most of the statements could be used to guide antithrombotic management following venous stenting. Further studies are required to clarify controversial issues including the dose and duration of anticoagulants, the role of antiplatelet agents, especially in patients with NIVL.
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Affiliation(s)
- Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Can Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanli Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Wayne W Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA
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Mezalek ZT, Feodor T, Chernukha L, Chen Z, Rueda A, Sánchez IE, Ochoa AJG, Chirol J, Blanc-Guillemaud V, Lohier-Durel C, Ulloa JH. VEIN STEP: A Prospective, Observational, International Study to Assess Effectiveness of Conservative Treatments in Chronic Venous Disease. Adv Ther 2023; 40:5016-5036. [PMID: 37728696 PMCID: PMC10567827 DOI: 10.1007/s12325-023-02643-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION VEIN STEP was conducted to collect international data on the management of chronic venous disease (CVD) and to assess the effectiveness of conservative treatments for the relief of CVD signs and symptoms. METHODS This international, observational, prospective, longitudinal, cohort study recruited adult outpatients consulting for symptomatic CVD. The primary objective was the effectiveness of conservative treatments on symptoms, signs and quality of life in a real-life setting assessed using a range of patient-reported outcome measures: 10-cm Visual Analog and Patient Global Impression of Change scales for symptoms; Venous Clinical Severity Score for physician assessment of signs; and 14-item ChronIc Venous Insufficiency Questionnaire (CIVIQ-14) for quality of life. At inclusion, patients were prescribed conservative treatment according to the physicians' usual practice. Follow-up visits took place at weeks 2 and 4, with an optional week 8 visit. RESULTS The analysis set comprised 6084 subjects (78% female) from nine countries with a mean age of 50.6 ± 13.8 years and BMI of 28.0 ± 4.9 kg/m2. The most common CEAP classifications were C1 (23.0%), C2 (31.6%), and C3 (30.7%). Conservative therapy consisted of oral venoactive drugs (VADs; 95.8% of subjects) including micronized purified flavonoid fraction (MPFF 75.5%) and diosmin (18.8%), compression (52.0%), and topicals (31.5%). Conservative therapy led to global symptom improvement in 89% of patients after 2 weeks and 96% at 4 weeks. Pain, leg heaviness, cramps, and sensation of swelling were improved in 82%, 71%, 45.5%, and 46% of patients, respectively. Conservative therapy was associated with a decrease over time in patient-assessed global symptom intensity: - 2.37 ± 1.73 (P < 0.001) and physician-assessed disease severity - 1.83 ± 2.82 (P < 0.001). Among the VADs, MPFF-based conservative therapy was associated with the greatest reduction in symptom and sign intensity. Improvements in CIVIQ-14 were observed with all treatments but were greatest for MPFF. CONCLUSION In this prospective study conducted in the real-world setting, treatment with conservative therapy, in particular MPFF, was associated with meaningful improvements in the clinical signs and symptoms of disease as well as in quality of life in patients with CVD. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04574375.
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Affiliation(s)
- Zoubida Tazi Mezalek
- Service de Médecine Interne, Hématologie Clinique, Centre Hospitalo-Universitaire Ibn Sina, Université Mohammed V de Rabat, Rabat, Morocco
| | - Toni Feodor
- Vascularte Interdisciplinar Clinics SRL, Bucharest, Romania
| | | | - Zhong Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ana Rueda
- Honduras Medical Center, Tegucigalpa, Honduras
| | | | | | | | | | | | - Jorge Hernando Ulloa
- Fundación Santa Fe de Bogotá, Universidad de los Andes, Asociación Médica De Los Andes, Cra 9 # 116-20, Cons 910, Bogota, Colombia.
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Milic DJ, Zivic SS, Bogdanovic DC, Lazarevic MV, Ademi BN, Milic ID. The influence of different sub-bandage pressure values in the prevention of recurrence of venous ulceration-A ten year follow-up. Phlebology 2023; 38:458-465. [PMID: 37343246 DOI: 10.1177/02683555231184776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE The aim of this study was to establish the efficacy of three different strengths of compression systems in the prevention of venous leg ulcer (VLU) recurrences during a 10-year follow up period. METHODS An open, prospective, randomized, single-center study included 477 patients (240 men, 237 women; mean age 59 years). Patients were randomized into three groups: Group A) 149 patients (allocated to wear elastic stocking 18-25 mmHg). Group B) 167 patients (wearing compression device exerting 25-35 mmHg), and Group C) 161 patients (treated with multilayer compression system exerting 35-50 mmHg). RESULTS Overall, 65% (234/360) of patients had recurrent VLU within 10 years. Recurrence occurred in 120 (96%) of 125 in group A, in 89 (66.9%) of 133 patients in group B and in 25 (24.5%) of 102 patients in group C (p < 0.05). CONCLUSION Compression systems with the higher compression class provide lower recurrence rate.
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Affiliation(s)
- Dragan J Milic
- Clinic for Cardiovascular and Transplant Surgery, Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Sasa S Zivic
- Clinic for Cardiovascular and Transplant Surgery, Clinical Center Nis, Nis, Serbia
| | | | - Milan V Lazarevic
- Clinic for Cardiovascular and Transplant Surgery, Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Bekim N Ademi
- University Clinical Centre of Kosovo, Hospital District, Prishtina, Kosovo
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Tsai CK, Nfor ON, Tantoh DM, Lu WY, Liaw YP. The association between vegetarian diet and varicose veins might be more prominent in men than in women. Front Nutr 2023; 10:1046158. [PMID: 37324727 PMCID: PMC10267867 DOI: 10.3389/fnut.2023.1046158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background Varicose veins (VVs), a common vascular disease is associated with a huge medical burden. The prevalence in women surpasses that in men. The role of vegetarian diets in the pathogenesis of the disease remains inconclusive. In this study, we examined the risk of VVs in vegetarian and non-vegetarian men and women. Methods The study involved 9905 adults whose data were obtained from Taiwan Biobank between 2008 and 2020. Information on VVs, sex, and vegetarian diets was obtained from participants' self-responses to the Taiwan Biobank questionnaires. Results The study subjects consisted of 4,142 men and 5,763 women. About 12% of men and 35% of women had VVs. Study participants were predominantly non-vegetarians (91.84% were men and 88.24% were women). Women had a higher risk of VVs than men. The odds ratio (OR); 95% confidence interval (CI) was 3.414; 2.995-3.891. There was a significant interaction between sex and vegetarian diets (p = 0.0034). Women were at higher risk of VVs than men both in the vegetarian (OR = 1.877, 95% CI = 1.270-2.774) and non-vegetarian (OR = 3.674, 95% CI = 3.197-4.223) groups. Based on vegetarian diets, only vegetarian men had a higher risk of VVs (OR = 1.453, 95% CI = 1.069 to 1.976). Based on the sex-stratified model, the risk of VVs was significantly higher in vegetarian men (OR = 1.457, 95% CI = 1.072-1.979), and in vegetarian and non-vegetarian women with corresponding ORs (95% CI) of 3.101 (2.528-3.803) and 3.599 (3.140-4.124), respectively. Conclusion Women were more susceptible to varicose veins compared to men, regardless of diet. However, in terms of diet, only men who followed a vegetarian diet were at greater risk for developing VVs.
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Affiliation(s)
- Cheng-Ken Tsai
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Disline Manli Tantoh
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Yu Lu
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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de Oliveira Viana Pereira DM, de Souza Oliveira AC, de Oliveira Júnior SA, Jacinto MAG, Dionísio AJ, Lima AEO, da Silva Dantas BA, de Oliveira Sousa SL, Martínez CSG, de Vasconcelos Torres G. Correlation between Generic and Disease-Specific Quality of Life Questionnaires in Patients with Venous Ulcerations: A Cross-Sectional Study Carried out in a Primary Health Care Setting in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3583. [PMID: 36834277 PMCID: PMC9961915 DOI: 10.3390/ijerph20043583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Venous Ulcers (VU) are a serious health problem that affect the Quality of Life (QoL). They are evaluated by many different scales in the literature. We aimed to analyze the correlation between the Medical Outcomes Short-Form Health QoL (SF-36) and Charing Cross Venous Ulcer Questionnaire (CCVUQ) scales. This is a cross-sectional study conducted in a Brazilian center specializing in chronic VU of the Primary Health Care (PHC) provided to patients with active VU. The general QoL instrument SF-36 and the CCVUQ, specific for people with VU, were used. Spearman's Rho Test determined the correlation between the variables analyzed. Our sample had a total of 150 patients. We found a direct correlation between the domestic activities division (CCVUQ) aspect and the SF-36 Physical role functioning (strong), and Physical functioning (moderate) domains. The Social interaction division (CCVUQ) aspect presented moderate correlation with the domains of the SF-36 Physical role functioning and Physical functioning. The Vitality domain (SF-36) showed moderate correlation with the aspects of CCVUQ Cosmesis division and Emotional status division. The greatest forces of direct correlation were observed between the physical, functional and vitality aspects of SF-36 with those represented by domestic activities and social interaction in the CCVUQ.
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Affiliation(s)
| | | | - Severino Azevedo de Oliveira Júnior
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Av. Olavo Lacerda Montenegro n. 2685, Parnamirim 59158-400, Brazil
| | - Maria Angélica Gomes Jacinto
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Av. dos Caiapós n. 121, Bairro Pitimbú, Natal 59067-400, Brazil
| | - Alessandra Justino Dionísio
- Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte (UFRN), Rua dos Palmares, 30, Parque das Árvores, Parnamirim 59154-145, Brazil
| | - Alana Ellen Oliveira Lima
- Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte (UFRN), Av. Maria Lacerda Montenegro nº 339, Parnamirim 59152-900, Brazil
| | - Bruno Araújo da Silva Dantas
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Rua Alice Azevedo, 30, Natal 59080-015, Brazil
| | | | - Carmelo Sergio Gómez Martínez
- Facultad de Enfermería, Universidad Católica de Murcia (UCAM), Calle Orden de Santiago, num 5, Abarán-Murcia, 30550 Murcia, Spain
| | - Gilson de Vasconcelos Torres
- Centro de Ciências da Saúde, Research Productivity Scholarship (CNPQ/PQ1D), Universidade Federal do Rio Grande do Norte (UFRN), Rua das Massarandubas, 292, Nova Parnamirim, Parnamirim 59150-630, Brazil
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Metabolic Profiling Reveals Changes in Serum Predictive of Venous Ulcer Healing. Ann Surg 2023; 277:e467-e474. [PMID: 35916649 PMCID: PMC9831039 DOI: 10.1097/sla.0000000000004933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration. SUMMARY BACKGROUND DATA Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies. METHODS Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy. RESULTS A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy. CONCLUSIONS This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.
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Thibert A, Briche N, Vernizeau BD, Mougin-Guillaume F, Béliard S. Systematic review of adapted physical activity and therapeutic education of patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1385-1400. [PMID: 35810994 DOI: 10.1016/j.jvsv.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/04/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic venous disease (CVD), comprising impaired lower limb venous return, will lead to chronic distal venous pressure overload manifested by various clinical signs and symptoms and resulting in diminished quality of life. The CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification of CVD distinguishes six stages (C0-C6) using clinical, etiologic, anatomic, and pathophysiologic parameters. In the present study, we analyzed the effects of adapted physical activity (APA) and patient-oriented therapeutic education (PTE) programs on the clinical signs, symptoms, and quality of life of patients with CVD. METHODS Our analysis, in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations, included a search of PubMed, CINAHL and LiSSa databases, using a single search equation. RESULTS A total of 21 studies were selected for analysis. The analysis revealed first, that patients at stage C0 to C5 had had access to an APA program. This therapy alleviated the clinical signs and symptoms and improved the patients' quality of life. The beneficial effects of APA were greater in the programs that had included aquatic activities than in the program that were exclusively dry-land programs. Second, patients at stage C6 had predominantly followed a PTE program. This therapy showed beneficial effects on the clinical signs and symptoms. However, the quality of life had rarely been assessed. CONCLUSIONS At present, APA and PTE programs comprise useful and complementary therapeutic options for the care of patients with CVD. Two of the studies included in our review had evaluated the effects of combining these two approaches, notably in the context of balneotherapy, and reported promising results.
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Affiliation(s)
- Axelle Thibert
- Independent Adapted Physical Activity Teacher, Dole, France; Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | - Nicolas Briche
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | | | - Fabienne Mougin-Guillaume
- EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France
| | - Samuel Béliard
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France; EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France; PEPITE EA4267, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, Besançon, France.
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12
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Bogachev V, Boldin B, Turkin P, Samenkov A, Dzhenina O. Micronized purified flavonoid fraction-based conservative treatment of chronic venous disease in a real-world setting. Future Cardiol 2022; 18:777-785. [PMID: 36004765 DOI: 10.2217/fca-2022-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aims: To investigate the effectiveness and tolerability of adjunctive micronized purified flavonoid fraction (MPFF) in patients with chronic venous disease (CVD). Patients & methods: This observational study included adults (≥18 years) with clinical-etiology-anatomy-pathophysiology (CEAP) class C4 CVD for whom MPFF was indicated. Outcomes included changes in subcutaneous adipose thickness, venous clinical severity score, CVD symptoms (using a visual analogue scale) and tolerability. Results: Of 381 patients, 365 completed the study. After 6 months, subcutaneous adipose tissue thickness, venous clinical severity score and visual analogue scale scores significantly improved (all p < 0.001 vs baseline). No adverse drug reactions occurred. Conclusion: Adjunctive MPFF treatment improves skin and subcutaneous tissue conditions in CVD patients. Clinical Trial Registration: NCT04138576 (ClinicalTrials.gov).
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Affiliation(s)
- Vadim Bogachev
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Boris Boldin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Pavel Turkin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Alexander Samenkov
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Olga Dzhenina
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
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13
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Dialsingh I, Mohammed SR, Medford RS, Budhoo E, White-Gittens I, Maharaj D. Conservative therapy significantly reduces patients' chronic venous disease symptoms: A Caribbean insight into the VEIN Act Program. Phlebology 2022; 37:651-661. [PMID: 35848710 DOI: 10.1177/02683555221114542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to determine the baseline demographic and clinical characteristics of patients with Chronic Venous Disease (CVD) across the Caribbean, and to evaluate patients' compliance to conservative therapy and the effectiveness of such therapy in reducing patients' CVD symptoms. METHOD Patients were enrolled into the VEIN Act Program, and their demographic data, CVD symptoms (and their intensity) and CEAP C-classification was recorded at the first visit. Patients were prescribed conservative therapy, and symptom intensity and patient compliance and satisfaction evaluated at a follow-up visit. RESULTS We enrolled 193 patients into the study, most of which (76%) were female, between 39-78 years (80%) and within the C2-C4a classes (56.1%). Pain (61.1%) and heaviness (58.5%) were the most common symptoms. Patient compliance to the prescribed treatment was relatively high for all modalities (>75%) and most patients (92.1%) were at least somewhat satisfied with their treatment. CONCLUSIONS Patient compliance to conservative therapy for management of CVD is high across the Caribbean, and such therapy is effective in reducing intensity of CVD symptoms.
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Affiliation(s)
- Isaac Dialsingh
- Department of Mathematics and Statistics, Faculty of Science and Technology, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Saeed Rashaad Mohammed
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Rei Sebastian Medford
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Emerson Budhoo
- Caribbean Orthopaedic Foot and Ankle Institute, Medical Associates Hospital, St Joseph, Trinidad
| | | | - Dale Maharaj
- Caribbean Vascular and Vein Clinic, St Clair Medical Center, Port of Spain, Trinidad
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Espeit L, Rimaud D, Le Mat F, Cudel C, Micol I, Bertoletti L, Chaigneau C, Millet GY, Lapole T. Fatigue, physical activity and quality of life in people self-reporting symptoms of chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1147-1154.e1. [PMID: 35714904 DOI: 10.1016/j.jvsv.2022.04.016] [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: 01/17/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to quantify fatigue and quality of life (QoL) in people self-reporting chronic venous disease (CVD) symptoms or at risk of CVD within a large cohort representative of the French population. The relationship between self-reported physical activity and both fatigue and QoL was also investigated. We hypothesised that a greater fatigue and impaired QoL would exist in participants self-reporting CVD symptoms, with the impairments being attenuated in those with greater level of physical activity. METHODS Using a web-based, custom and adaptive survey, 3,008 participants were asked to self-report the presence of common symptoms and risk factors of CVD. Fatigue, QoL and physical activity were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-14) and the Godin-Shepard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), respectively. RESULTS 32% of the participants were categorized as having CVD symptoms whereas 50% were categorized as at risk of CVD. Fatigue was greater in participants with CVD symptoms than non-CVD participants (p < 0.001), with the score of participants at risk of CVD being intermediate (p ≤ 0.001). QoL was more impaired in participants with CVD symptoms compared to participants at risk of CVD (p < 0.001). In participants with CVD symptoms, there were relationships between fatigue and QoL (p < 0.001) and between physical activity and fatigue (p < 0.001). Despite the relationship between physical activity and QoL not reaching significance (p = 0.067), a lower QoL was found in insufficiently active as compared to active (p < 0.001) and moderately active (p < 0.001) participants with CVD symptoms. CONCLUSIONS Participants self-reporting CVD symptoms suffer from greater fatigue and impaired QoL. In this population, a higher level of physical activity is associated with reduced fatigue and a tendency toward improved QoL.
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Affiliation(s)
- Loïc Espeit
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Diana Rimaud
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Franck Le Mat
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Claire Cudel
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Isabelle Micol
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Saint-Etienne, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, SAINBIOSE, UJM Saint-Etienne, F-42055, Saint-Etienne, France; INSERM, CIC1408, CHU Saint-Etienne, F-42055, Saint-Etienne, France
| | - Cyril Chaigneau
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Guillaume Y Millet
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France; Institut Universitaire de France (IUF)
| | - Thomas Lapole
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France.
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Hall N, Krysa J, Lesche S, Hill BG, Letts JA, McNaughton A, Clifford K, Jones GT. Near infra-red fluorescence imaging to demonstrate reflux in the superficial microvenous network of the leg. Eur J Vasc Endovasc Surg 2022; 64:377-386. [PMID: 35667596 DOI: 10.1016/j.ejvs.2022.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Reflux within the superficial microvenous network may play a critical role in the development of skin changes which can be associated with chronic venous insufficiency. This study aimed to determine if near infra-red fluorescence (NIRF) imaging could be used to accurately determine superficial venous reflux in the leg. METHODS A total of nine limbs were examined ex vivo from patients undergoing limb amputation for peripheral arterial disease. Cannulation of the distal great saphenous vein was used to sequentially perform X-ray contrast enhanced venography, NIRF imaging and venous corrosion casts. RESULTS Fluorescence imaging visualised a range of different microvenous reflux patterns ex vivo, which were generally not evident by x-ray venography, but were consistent with retrograde resin vascular casts. These included both focal and diffuse regions of fluorescence within the skin and, consistent with previous observations, the vascular casts indicated that regions of venous reflux were typically associated with incompetent valves. CONCLUSION The findings from this study suggest a potential method for investigating early stage superficial venous disease, prior to the appearance of visible signs of advanced venous disease, such as skin changes. However, further studies are required to confirm the, in vivo, clinical utility of these observations.
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Affiliation(s)
- Nicholas Hall
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Jolanta Krysa
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Sarah Lesche
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Brigid G Hill
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - James A Letts
- Radiology Department, Southern District Health Board, Dunedin, New Zealand
| | - Andrew McNaughton
- Otago Micro and Nanoscale Imaging (OMNI), University of Otago, Dunedin, New Zealand
| | - Kari Clifford
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand.
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Carpentier PH, Satger B, Sandrin B. Patient Education in Spa Resorts: Experience from a French National Program for Patients with Chronic Venous Insufficiency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031176. [PMID: 35162199 PMCID: PMC8834367 DOI: 10.3390/ijerph19031176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
The prognosis of chronic venous insufficiency (CVI) is greatly depending upon the ability of the patients to optimize their health-related behaviors (mainly compliance to compression stockings, physical activity and diet). As this is usually challenging for the patients, we developed a therapeutic education program (TEP) aiming at helping them to achieve these optimizations. We report here the preliminary results obtained with this program. This structured TEP was developed by a working group of 15 health professionals to be used during the regular French spa 3-week treatment course for CVI patients. The program included three interactive workshops aiming at improving the patients’ knowledge, skills and motivation, two educational consultations allowing to set and follow-up their personal action plans and a built-in evaluation. It was implemented in spa resorts specialized in CVI. Among the first 150 patients (116 women and 34 men, mean age 69 years old (SD 8 years), 49% had post-thrombotic disease. Compliance to the education workshops was 98%. After a 3-month follow-up, 83% of the patients fully achieved at least one behavioral objective. Quality of life, as assessed by the CIVIQ 2 auto-questionnaire, improved at 3 months (p = 0.0024) and 9 months (p = 0.018). These results demonstrate the feasibility of a TEP for CVI patients and its ability to improve their health-related behaviors, opening the way for the development of similar programs for other chronic diseases in the setting of spa resorts.
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Affiliation(s)
- Patrick H. Carpentier
- Centre de Recherche Universitaire de La Léchère, Université Grenoble-Alpes, 73260 La Léchère, France;
- Correspondence: ; Tel.: +33-4-7922-6265
| | - Bernadette Satger
- Centre de Recherche Universitaire de La Léchère, Université Grenoble-Alpes, 73260 La Léchère, France;
| | - Brigitte Sandrin
- Association Française pour le Développement de l’Education Thérapeutique 18, Passage de la Bonne Graine, 75011 Paris, France;
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Veličković VM, Szilcz M, Milošević Z, Godfrey T, Siebert U. Cost-effectiveness analysis of superabsorbent wound dressings in patients with moderate-to-highly exuding leg ulcers in Germany. Int Wound J 2021; 19:447-459. [PMID: 34342156 PMCID: PMC8762557 DOI: 10.1111/iwj.13645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022] Open
Abstract
The study aims to estimate the cost‐effectiveness of superabsorbent wound dressings compared to the standard‐of‐care (SoC) dressings mix for treatment of patients with moderate‐to‐highly exuding leg ulcers in the German healthcare settings. A model‐based cost‐effectiveness analysis was conducted from the German statutory health insurance perspective, following German specific and international recommendations of good research practice. An individual‐level (microsimulation) state‐transition model has been used with a cycle length of 1 week and time horizon of 6 months. Several comprehensive systematic reviews were conducted to inform all model inputs, including clinical parameters, efficacy, quality of life, resources utilisation, and cost inputs. In addition, primary data from two clinical trials were used. Based on this cost‐effectiveness analysis, using superabsorbent wound dressings instead of the SoC dressings of patients with moderate‐to‐highly exuding leg ulcers in Germany can lead to an improved healing rate of 2.57% (benefit ratio 1.08), improved health‐related quality of life of 0.152 quality‐adjusted life weeks, and total direct cost savings of €771 per patient in 6 months. Robustness of results was confirmed in sensitivity and scenario analyses.
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Affiliation(s)
- Vladica M Veličković
- Health Economics and Outcome Research (HEOR) Department, HARTMANN GROUP, Heidenheim, Germany.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall, Tirol, Austria
| | - Mate Szilcz
- Medical Epidemiology and Biostatistics Department, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Zoran Milošević
- Faculty of Medicine, Biostatistics Department, University of Niš, Niš, Serbia
| | - Thomas Godfrey
- Health Economics and Outcome Research (HEOR) Department, HARTMANN GROUP, Heidenheim, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall, Tirol, Austria
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Lajos P, Safir S, Weber J, Bangiyev R, Faries P, Ting W. Utility of compression immediately after venous closure: Does it matter? Phlebology 2021; 36:841-847. [PMID: 34212789 DOI: 10.1177/02683555211028533] [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: 11/15/2022]
Abstract
BACKGROUND Leg compression after venous closures for 24-48 hours or longer is commonplace and controversial. OBJECTIVE The goal of our study was to evaluate compression immediately post-venous closures and its associated costs. METHODS Records were retrospectively reviewed after consecutive therapies of sclerotherapy, mechanochemical ablation (MOCA) & radiofrequency ablation (RFA) from 1 clinic with 2 cohorts: 7/2/13-10/15/15 were immediately ACE-wrapped for 3-5 days (AW, N = 52) and 10/20/15-1/5/16 were non ACE-wrapped (NAW, N = 49). All procedures were performed in an outpatient office setting of one surgeon (P.L.). Follow-up was within 1 week and 3 months with ultrasounds. Financial data of ACE wraps and ABD pads were assessed. RESULTS Closures consisted of consecutive therapies of sclerotherapy (4 patients); MOCA (44 patients) and RFA (53 patients). No statistical difference existed in age (p = 0.61), sex (p = 0.2063); race (0.3689), CAD (p = 0.1442), ESRD (p = 0.2914), diabetes mellitus (p = 0.8943), hypertension (p = 0.681), COPD (p = 0.38), or smoking (p = 0.3628). NAW group had higher rate of hyperlipidemia (p = 0.0225), obesity (p = 0.0283), MOCA and sclerotherapy (p = 0.0005). No difference existed in pain (p = 0.8897); wound complications were too small to perform analysis; and swelling was greater in AW group compared to NAW group (p = 0.0132, OR 3.3951, CI 1.269; 9.0834). Closure rates were 98% and 100% in AW and NAW groups, respectively. NAW were only a total cost savings of $1.58 per leg per procedure. CONCLUSION AW for compression after vein closures confers no benefit in postoperative period with no effect on closure rates; may be associated with increased swelling, discomfort, and wound complications while increasing unnecessary and negligible monetary costs. Larger sample size is needed to validate these conclusions.
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Affiliation(s)
- Paul Lajos
- Division of Vascular Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - Scott Safir
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
| | - Jonathan Weber
- Departments of Research and Cardiac Imaging, St Francis Hospital, Roslyn, NY, USA
| | - Ronald Bangiyev
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
| | - Peter Faries
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
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Stücker M, Münter KC, Erfurt-Berge C, Lützkendorf S, Eder S, Möller U, Dissemond J. Multicomponent compression system use in patients with chronic venous insufficiency: a real-life prospective study. J Wound Care 2021; 30:400-412. [PMID: 33979221 DOI: 10.12968/jowc.2021.30.5.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Compression therapy is the cornerstone of therapeutic management of patients with chronic venous insufficiency (CVI). This study aimed to evaluate the efficacy and safety of a multicomponent compression system in an unselected population of patients with CVI problems under real-life conditions. METHOD A prospective, multicentre, observational study with a multicomponent two-bandage compression system (UrgoK2, Laboratoires Urgo, France) was conducted in 103 centres in Germany. Main outcomes included wound healing rate, wound healing progression, assessment of oedema and ankle mobility, local tolerability and acceptance of the compression therapy. RESULTS A total of 702 patients with venous leg ulcers (VLU) and/or with lower limb oedema due to CVI were treated with the evaluated system for a mean (±standard deviation) duration of 27±17 days. By the last visit, 30.9% of wounds had healed and 61.8% had improved. Limb oedema was resolved in 66.7% of patients and an improvement of ankle mobility was reported in 44.2% of patients. The skin condition under the compression therapy was also considered as improved in 73.9% of patients and a substantial reduction of pain was achieved, both in number of patients reporting pain and in pain intensity. Compression therapy with the evaluated system was 'very well' or 'well' tolerated and 'very well' or 'well' accepted by >95% of patients. These positive outcomes were in line with the general opinion of physicians on the evaluated compression bandages, which were judged 'very useful' or 'useful' for >96.6% of patients. Similar results were reported regardless of the treated condition, VLU and/or limb oedema. CONCLUSION Real-life data documented in this large observational study of non-selected patients receiving compression therapy in daily practice confirm the benefits and safety profile of the evaluated compression system. This study also confirms the high-level of performance and acceptability of the system, regardless of the characteristics of the wounds or patients at initiation of the treatment. The data support the use of this multicomponent compression system as one first-line intervention in patients with symptoms caused by CVI.
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Affiliation(s)
- Markus Stücker
- Vein Centre of the Dermatology and Vascular Surgery Clinics, Hospital of Ruhr-University Bochum, St. Maria-Hilf Hospital, Venenzentrum, Bochum, Germany
| | | | - Cornelia Erfurt-Berge
- Department of Dermatology, Venereology, and Allergology, University Hospital Erlangen, Erlangen, Germany
| | | | - Stephan Eder
- Department of Vascular Surgery and Vascular Medicine, Schwarzwald-Baar Hospital Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Udo Möller
- Medical Affairs and Clinical Research Department, URGO GmbH, Sulzbach, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
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Maitz E, Binder B. [Treatment of chronic hard-to-heal wounds with hyaloronic acid ester: a case series of six patients]. Wien Med Wochenschr 2021; 172:52-56. [PMID: 33738631 PMCID: PMC8837515 DOI: 10.1007/s10354-021-00831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
The treatment of chronic wounds is usually a major challenge for the involved medical staff. Various different treatment options have to be tested achieving a satisfactory result. In this retrospective case report, we describe successful treatments with hyaluronan acid ester fleece in six patients with chronic wounds of different origins. Furthermore, all patients received compression bandages or compression stockings, two patients were treated additionally with pressure relief devices and all were debrided if necessary. The chronic wounds of five out of the six patients healed completely over a period of 1.5-11 months or only with a minimal residual defect. However, one patient was still resistant to therapy over five months. In summary, the treatment with hyaluronan esters achieved good results especially in patients with complex medical history that makes a successful therapy particularly difficult.
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Affiliation(s)
- Emanuel Maitz
- Univ.-Klinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - Barbara Binder
- Univ.-Klinik für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Österreich.
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21
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Mazuchová J, Halašová E, Mazuch J, Šarlinová M, Valentová V, Franeková M, Zelník Š, Krkošková K, Javorka K, Péč M, Grendár M. Investigation of association between genetic polymorphisms of MMP2, MMP8, MMP9 and TIMP2 and development of varicose veins in the Slovak Population - pilot study. Physiol Res 2020; 69:S443-S454. [PMID: 33471544 DOI: 10.33549/physiolres.934597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Matrix metalloproteinases (MMPs) are a family of zinc-dependent metalloendopeptidases that degrades extracellular matrix (ECM) components. MMPs are associated with venous wall remodelling, proliferation, migration, phenotypic and functional transformation of vascular smooth muscle cells and ECM organization under the physiological and pathophysiological conditions. We investigated possible association of genetic promoter polymorphisms of MMP2 (rs243866), MMP8 (rs11225395), MMP9 (rs3918242) and TIMP2 (rs8179090) to varicose veins development in the Slovak population. Genomic DNA from 276 Slovak individuals (138 cases, 138 controls) was genotyped for selected SNPs (rs243866, rs11225395, rs3918242 and rs8179090) using the PCR-RFLP analysis. The data were analysed by chi-squared (chi2) test, logistic regression, and Mann-Whitney test. The risk of varicose veins development was evaluated in dominant, codominant and recessive genetic models. The statistical evaluation of selected polymorphisms in patients in all three genetic models has not shown a significant risk of varicose veins development. Our study has not shown the association between selected polymorphisms and increased risk of varicose veins development in Slovak population. More evidence with broaden sample size is needed.
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Affiliation(s)
- J Mazuchová
- Department of Medical Biology, Jessenius Faculty of Medicine, Martin, Slovakia.
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AlBader B, Sallam A, Moukaddem A, Alanazi K, Almohammed S, Aldabas H, Algmaizi S. Prevalence of Varicose Veins Among Nurses at Different Departments in a Single Tertiary Care Center in Riyadh. Cureus 2020; 12:e12319. [PMID: 33520517 PMCID: PMC7835718 DOI: 10.7759/cureus.12319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Varicose veins (VV) is a chronic venous disease that affects the lower extremities. It is the dilation of subcutaneous veins, three to four millimeters in diameter. VV can be attributed to several risk factors such as age, obesity, multiple parities, heavy lifting, and long-standing hours. Direct and indirect complications can occur due to VV. Several studies were conducted to estimate the prevalence of VV. Methods A self-administered questionnaire was used to estimate the prevalence of VV among nurses from different departments in the National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia. The questionnaire included questions on weight, height, work history, lifestyle, and multiple diseases. The chi-square test and Fisher’s exact test were used for testing the association between the various predictors and the diagnosis of VV. Results A total of 366 nurses participated in the study. There were 40 (39 females and one male) cases of VV accounting for 11.0%. Variables that have a statistically significant association with VV were social status and lifting heavy objects (p=0.02), a family history of VV (p-value=<0.001), and the number of childbirths (p=0.04). The observation of each department was not statistically significant with VV (p=0.35). Conclusion Among nurses, positive family history, age, marital status, long-standing hours, and heavy object lifting were significant risk factors for the development of VV. However, the prevalence of VV in the four departments was low.
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Affiliation(s)
- Bader AlBader
- Family Medicine, King Abdulaziz Medical City, Riyadh, SAU
| | - Asma Sallam
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Afaf Moukaddem
- Medical Education, King Saud Bin Abdulaziz University for Health Science, Riyadh, SAU
| | - Kout Alanazi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sara Almohammed
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Haya Aldabas
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Shahad Algmaizi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Cavezzi A. Medicine and Phlebolymphology: Time to Change? J Clin Med 2020; 9:E4091. [PMID: 33353052 PMCID: PMC7766771 DOI: 10.3390/jcm9124091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients' management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients' lack of education, industry-influenced science, and physician's improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.
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Time trends and social security burden of temporary work disability due to chronic venous disease in Brazil. BMC Public Health 2020; 20:477. [PMID: 32276612 PMCID: PMC7147047 DOI: 10.1186/s12889-020-08563-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 03/20/2020] [Indexed: 11/12/2022] Open
Abstract
Background Chronic venous disease (CVD) and disability are worldwide problems and have significant socioeconomic implications. This study aims to analyze the time trends and social security burden of temporary work disability due to CVD in Brazil. Methods An ecological time series study using the Brazilian Social Security System database was performed from 2005 to 2014. Data from all benefits granted to workers with temporary disability due to CVD were analyzed. The cases were identified using diagnosis codes I83–I83.9 of the International Classification of Diseases 10th Revision (ICD-10). The time trend analyses were performed by the Joinpoint Regression Model, with sex, age, regions, income, and category of affiliation as variables. Crude and age-standardized rates were calculated. Results A total of 429,438 benefits were granted for temporary work disability due to CVD from 2005 to 2014, with a growing trend and an age-standardized annual percent change (APC) of 3.4 (95% CI: 2.6–4.2) (p < 0.05). Social security expense increased 3.5-fold, and the number of days in benefit doubled from 2005 to 2014. In total, 27,017,818 working days were lost. The average duration of benefits was 55.3 days. The majority of workers were women (68.2%) (p < 0.001), between 30 and 59 years old, employed, had a monthly income ≤2 minimum wages (MW) (83.2%), and lived in the regions southeast (53.6%) and south (29.3%). Significantly higher APCs were observed for women than for men (APC: 4.9, 95% CI: 4.0–5.7 versus APC: 1.2, 95% CI: 0.1–2.4). All regions in Brazil had a significant growing trend, except in the north. No significant growth was observed in the age group of 60–69 years. A decreasing trend was observed in workers with monthly incomes above 2 MW (p < 0.05). Conclusions Temporary work disability due to CVD and social security burden showed increasing trends with millions of working days lost, particularly among women and low-income workers. Preventing disability is challenging, and public policies are needed to reduce the social and economic impact of disability. Therefore, measures for promoting health at the workplace should be encouraged.
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25
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Heatley F, Saghdaoui LB, Salim S, Onida S, Davies AH. Primary care survey of venous leg ulceration management and referral pre-EVRA trial. Br J Community Nurs 2020; 25:S6-S10. [PMID: 33300844 DOI: 10.12968/bjcn.2020.25.sup12.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous leg ulceration (VLU) is a public health concern that is largely managed in community settings. The present study aimed to survey current VLU management in the community. A 14-question survey was distributed to primary care professionals, and 90 responses were received. Some 54% of respondents stated that they would assess ankle brachial pressure indices (ABPI) for those with VLU, while 25% reported that they would not. Additionally, 62% reported not organising duplex ultrasound scanning. Compression therapy was offered by 82% of respondents. When asked whether VLU patients were referred to specialist services in secondary or tertiary care, some 32% reported that they would. However, 57% reported that, if a study suggested that referral to specialist services was beneficial, they would change their practice. On the basis of the findings, the authors concluded that there is diversity in VLU diagnostic and treatment pathways. New, high-quality evidence may improve practice, but care delivery is influenced by local factors including time and resource distribution.
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Affiliation(s)
| | - Layla Bolton Saghdaoui
- Pre-doctoral Clinical Fellow/Clinical Research Nurse, Vascular Surgery Research Department, Imperial College Healthcare NHS Trust
| | - Safa Salim
- Clinical Research Fellow, Division of Surgery, Imperial College London
| | - Sarah Onida
- Clinical Lecturer, Faculty of Medicine, Department of Surgery and Cancer, Imperial College London
| | - Alun Huw Davies
- Professor of Vascular Surgery and Honorary Consultant, Imperial College Healthcare NHS Trust
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A systematic review assessing the quality of clinical practice guidelines in chronic venous disease. J Vasc Surg Venous Lymphat Disord 2020; 9:787-791.e3. [PMID: 33249107 DOI: 10.1016/j.jvsv.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our aim was to assess the methodologic quality of clinical practice guidelines (CPGs), which inform the diagnosis and management of chronic venous disease (CVD), using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. METHODS A systematic review was performed through the Medline and Embase databases to identify CPGs relevant to CVD. The included articles were evidence-based CPGs available in English and reported in the past 20 years. Consensus documents, expert opinions, and studies providing guidance for diagnosis or treatment alone were excluded. Four independent reviewers assessed the CPGs using the AGREE II tool across six domains. Overall quality scaled scores were calculated for each guideline, and the interrater reliability was measured using an intraclass correlation coefficient. SPSS, version 25 (IBM Corp, Armonk, NY) was used for statistical analysis. RESULTS Six CPGs reported from 2004 to 2018 were identified; all were of European and North American origin. The interrater reliability when scoring each CPG was high, with an intraclass correlation coefficient of >0.8 (P ≤ .002) for all six CPGs. One CPG had an average score of 95.83% across all domains, qualifying as a high quality CPG. The remaining five CPGs had scores ranging from 29% to 71%. The CPGs generally performed poorly in outlining stakeholder involvement and evaluating the applicability of the guideline to clinical practice. CONCLUSIONS Scores from the AGREE II tool were reproducible when different users evaluated the CPGs. We identified one CPG for CVD of high methodologic quality. The AGREE II appraisal tool can be used to identify aspects of CPGs that can be developed to improve their methodologic quality.
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Kuhn J, Sultan DL, Waqas B, Ellison T, Kwong J, Kim C, Hassan A, Rabbani PS, Ceradini DJ. Nrf2-activating Therapy Accelerates Wound Healing in a Model of Cutaneous Chronic Venous Insufficiency. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3006. [PMID: 33299679 PMCID: PMC7722614 DOI: 10.1097/gox.0000000000003006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
Supplemental Digital Content is available in the text. Background Chronic venous insufficiency (CVI) stems from venous hypertension, extravasation of blood, and iron-rich skin deposits. The latter is central to ulcer development through generating reactive oxygen species (ROS) that drive persistent local inflammation and the development of lipodermatosclerosis. The ability to study CVI cutaneous inflammation is fundamental to advancing therapies. To address this end, a novel protocol was adapted to investigate cutaneous wound healing in iron-induced inflammation. Methods: Mice were injected subcutaneously or intraperitoneally with iron-dextran, and excisional wounding was performed. Histologic and biomolecular analysis was performed. Results: Iron loading was associated with dense iron deposits similar to those in chronic venous stasis. Subcutaneous but not intraperitoneal loading resulted in dermal collagen expansion. Iron overload was associated with atypical antioxidant expression as compared to vehicle controls (p < 0.0001) as well as delayed wound healing by 3-4 days. A potent activator of Nuclear factor erythroid 2-related factor 2 (Nrf2), a major transcriptional regulator of redox status, was applied to establish therapeutic efficacy. Nrf2 activation in the wound resulted in significant reduction of closure times across all experimental arms. Antioxidant expression following topical treatment was significantly increased for intraperitoneally iron-loaded mice (p < 0.0001) but did not achieve significance for the subcutaneously-loaded animals. Conclusions: We have characterized a novel model of cutaneous iron-overload designed to advance our understanding of dysfunctional wound healing in CVI. Cutaneous changes of iron overload coincide with redox imbalance and delayed wound healing. By activating Nrf2, we demonstrate the regenerative potential of pro-antioxidant mediators in treating CVI related wound complications.
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Affiliation(s)
- Joseph Kuhn
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Darren L Sultan
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Bukhtawar Waqas
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Trevor Ellison
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Jennifer Kwong
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Camille Kim
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Absara Hassan
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Piul S Rabbani
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
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Global Epidemiology of Chronic Venous Disease: A Systematic Review with Pooled Prevalence Analysis. Ann Surg 2020; 274:971-976. [PMID: 33214466 DOI: 10.1097/sla.0000000000004631] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an updated estimate of the global prevalence of CVD and to comprehensively evaluate risk factors associated with this condition. BACKGROUND Chronic Venous Disease (CVD) is an important cause of morbidity internationally, but the global burden of this condition is poorly characterised. The burden of CVD must be better characterised to optimise service provision and permit workforce planning to care for patients with different stages of CVD. METHODS A systematic search in Ovid MEDLINE and Embase (1946 - 2019) identified 1271 articles. Full-text, English language articles reporting on the epidemiology of CVD in a general adult population were included. Data extraction was performed by two independent reviewers, in accordance with a pre-registered protocol (PROSPERO: CRD42019153656). STATA and Review Manager were used for quantitative analysis. A crude, unadjusted pooled prevalence was calculated for each Clinical (C) stage in the Clinical, Etiologic, Anatomic, Pathophysiologic (CEAP) classification and across different geographical regions. Qualitative analysis was performed to evaluate associated risk factors in CVD. RESULTS 32 articles across 6 continents were identified. 19 studies were included in the overall pooled prevalence for each Clinical (C) stage; pooled estimates were: C0 s: 9%, C1: 26%, C2: 19%, C3: 8%, C4: 4%, C5: 1%, C6: 0·42%. The prevalence of C2 disease was highest in Western Europe and lowest in the Middle East and Africa. Commonly reported risk factors for CVD included: female gender (OR 2·26, 95% CI 2·16-2·36, p < 0.001), increasing age, obesity, prolonged standing, positive family history, parity and Caucasian ethnicity. There was significant heterogeneity across the included studies. CONCLUSIONS CVD affects a significant proportion of the population globally however there is significant heterogeneity in existing epidemiological studies.
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Salim S, Heatley F, Bolton L, Khatri A, Onida S, Davies AH. The management of venous leg ulceration post the EVRA (early venous reflux ablation) ulcer trial: Management of venous ulceration post EVRA. Phlebology 2020; 36:203-208. [PMID: 33103957 PMCID: PMC7941504 DOI: 10.1177/0268355520966893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives This survey study evaluates current management strategies for venous ulceration and the impacts of the EVRA trial results. Methods An online survey was disseminated to approximately 15000 clinicians, through 12 vascular societies in 2018. Survey themes included: referral times, treatment times and strategies, knowledge of the EVRA trial and service barriers to managing venous ulceration. Data analysis was performed using Microsoft Excel and SPSS. Results 664 responses were received from 78 countries. Respondents were predominantly European (55%) and North American (23%) vascular surgeons (74%). Responses varied between different countries. The median vascular clinic referral time was 6 weeks and time to be seen in clinic was 2 weeks. This was significantly higher in the UK (p ≤ 0.02). 77% of respondents performed surgical/endovenous interventions prior to ulcer healing, the median time to intervention was 4 weeks. 31% of participants changed their practice following EVRA. Frequently encountered barriers to implementing change were a lack of operating space/time (18%). Conclusion Venous ulcers are not managed as quickly as they should be. An evaluation of local resource requirements should be performed to improve service provision for venous ulceration. When interpreting the results of this survey consideration should be given to the response rate.
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Affiliation(s)
- Safa Salim
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francine Heatley
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Layla Bolton
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amulya Khatri
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Rabe E, Régnier C, Goron F, Salmat G, Pannier F. The prevalence, disease characteristics and treatment of chronic venous disease: an international web-based survey. J Comp Eff Res 2020; 9:1205-1218. [PMID: 33079592 DOI: 10.2217/cer-2020-0158] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study assessed the characteristics of individuals with chronic venous disease (CVD) and their treatment pathways. Materials & methods: A web-based survey enrolled representative populations of adults from Brazil, Czech Republic, France, Hungary, Italy, Romania, Russia and Spain, and identified those self-reporting CVD. Results: A total of 22% of respondents had signs/symptoms of CVD. Individuals with CVD were generally older, female and obese, and had more comorbidities than the general population. Common initial symptoms were tiredness, heaviness, pain, swelling in legs and night cramps. Participants waited ∼1 year before seeking treatment but most did not initially consult a physician; those who did tended to have more severe disease. Conclusion: One in five adults had CVD, but most did not seek a physician's help.
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Affiliation(s)
- Eberhard Rabe
- Klinik und Poliklinik für Dermatologie und Allergologie (Emeritus), University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | | | - Fabienne Goron
- Harris Interactive, 5 Avenue du Château, 94300 Vincennes, France
| | - Ghislaine Salmat
- Harris Interactive, 5 Avenue du Château, 94300 Vincennes, France
| | - Felizitas Pannier
- Practice Dermatology & Phlebology, Helmoltzstr, 4-6, 53123 Bonn, Germany.,Department of Dermatology, University of Cologne, Cologne, Germany
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Saghdaoui LB, Onida S, Davies AH, Wells M. Why nurses in primary care need to be research active: the case of venous leg ulceration. Br J Community Nurs 2020; 25:422-428. [PMID: 32881607 DOI: 10.12968/bjcn.2020.25.9.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous leg ulceration (VLU) is predominantly managed in primary care by district nurses, however much of the research takes place in secondary care. This study aimed to identify to what extent nurses are involved in publishing VLU research and to ascertain how much VLU research is conducted in primary care. Three searches of literature published between 2015 and 2020 were undertaken, reviewing VLU publications on interventions, quality of life and qualitative research. Some 37% of intervention studies had one or more nurse authors, compared with 65% of quality of life studies and 86% of qualitative research publications. Of papers that providing details of recruitment, 39% of intervention and quality of life studies included primary care as a recruitment setting. Qualitative studies were more likely to recruit from primary as well as secondary care (50%). Nurses are involved in leading VLU research but are more likely to publish quality of life and qualitative research than intervention studies. The majority of nurse authors in this field are based in academic institutions. A minority of studies utilise primary care as a recruitment setting for VLU research. More must be done to enable VLU research in community settings and to promote the involvement of clinical nurses in research.
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Affiliation(s)
- Layla Bolton Saghdaoui
- Clinical Research Nurse and Pre-doctoral Fellow, Imperial College Healthcare NHS Trust and Imperial College London
| | - Sarah Onida
- National Institute for Health Research Clinical Lecturer in Vascular Surgery and Vascular Specialty Registrar, Imperial College Healthcare NHS Trust and Imperial College London
| | - Alun Huw Davies
- Professor of Surgery and Honorary Consultant, Imperial College Healthcare NHS Trust and Imperial College London
| | - Mary Wells
- Professor of Practice in Cancer Nursing and Lead Nurse for Research, Imperial College Healthcare NHS Trust and Imperial College London
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32
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Heatley F, Saghdaoui LB, Salim S, Onida S, Gohel MS, Davies AH. UK primary care survey of venous leg ulceration management and referral - Post-EVRA trial. Phlebology 2020; 36:48-53. [PMID: 32722985 PMCID: PMC8163521 DOI: 10.1177/0268355520944102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective Determine standards of referral and management of patients with venous leg ulceration in primary care after the release of the EVRA (A Randomized Trial of Early Endovenous Ablation in Venous Ulceration) study results. Methods An online questionnaire was disseminated over four months to professionals working within primary care. Results The survey received 643 responses. Of respondents, 90 (14%) had heard of the EVRA trial and 51 (8%) were familiar with the results. Of those who answered the following questions, 410 (69.1%) stated that referral to a vascular specialist must be made by the General Practitioner and 13 (2.2%) reported that they would always refer patients for secondary care assessment before the publication of EVRA. Considering the EVRA results, 128 (29%) reported that they would change practice regarding referral and would experience no barriers and 198 (45%) reported that they would like to refer earlier but is not their decision. Barriers to changing practice included local referral policies, training and time restrictions, 266 (59%) had heard of the NICE guideline (CG168) and 194 (43%) were aware of the recommendations for referral to a vascular service within two weeks for patients with an open or healed ulcer. Conclusion There is a considerable variation in local referral pathways for venous leg ulceration, and despite clinicians wanting to refer promptly, many primary care professionals are unable to. Unfortunately, the EVRA study alone may not change the overall practice, and work is needed to overcome barriers faced by primary care professionals.
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Affiliation(s)
- Francine Heatley
- Imperial Health Care NHS Trust, Imperial College London, London, UK
| | | | - Safa Salim
- Imperial Health Care NHS Trust, Imperial College London, London, UK
| | - Sarah Onida
- Imperial Health Care NHS Trust, Imperial College London, London, UK
| | - Manj S Gohel
- Addenbrookes Hospital, Imperial College, Cambridge, London, UK
| | - Alun H Davies
- Imperial Health Care NHS Trust, Imperial College London, London, UK
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Rossi FH, Kambara AM, Rodrigues TO, Rossi CB, Izukawa NM, Pinto IM, Thorpe PE. Comparison of computed tomography venography and intravascular ultrasound in screening and classification of iliac vein obstruction in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2020; 8:413-422. [DOI: 10.1016/j.jvsv.2019.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/22/2019] [Indexed: 10/24/2022]
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Mitchell A, Elbourne S. Lower limb assessment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:18-21. [PMID: 31917948 DOI: 10.12968/bjon.2020.29.1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Aby Mitchell
- Senior Lecturer, Adult Nursing, University of West London
| | - Scott Elbourne
- Lecturer, Nursing Associates and Adult Nursing, University of West London
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Onida S, Tan MKH, Kafeza M, Bergner RT, Shalhoub J, Holmes E, Davies AH. Metabolic Phenotyping in Venous Disease: The Need for Standardization. J Proteome Res 2019; 18:3809-3820. [PMID: 31617359 DOI: 10.1021/acs.jproteome.9b00460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Venous thromboembolism (VTE), chronic venous disease (CVD), and venous leg ulceration (VLU) are clinical manifestations of a poorly functioning venous system. Though common, much is unknown of the pathophysiology and progression of these conditions. Metabolic phenotyping has been employed to explore mechanistic pathways involved in venous disease. A systematic literature review was performed: full text, primary research articles on the applications of nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry (MS) in human participants and animals were included for qualitative synthesis. Seventeen studies applying metabolic phenotyping to venous disease were identified: six on CVD, two on VLU, and nine on VTE; both animal (n = 6) and human (n = 10) experimental designs were reported, with one study including both. NMR, MS, and MS imaging were employed to characterize serum, plasma, urine, wound fluid, and tissue. Metabolites found to be upregulated in CVD included lipids, branched chain amino acids (BCAA), glutamate, taurine, lactate, and myo-inositol identified in vein tissue. Upregulated metabolites in VLU included lactate, BCAA, lysine, 3-hydroxybutyrate, and glutamate identified in wound fluid and ulcer biopsies. VTE cases were associated with reduced carnitine levels, upregulated aromatic amino acids, 3-hydroxybutyrate, BCAA, and lipids in plasma, serum, thrombus, and vein wall; kynurenine and tricarboxylic acid pathway dysfunction were reported. Future research should focus on targeted studies with internal and external validation.
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Affiliation(s)
- Sarah Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer , Imperial College London , Floor 4 East, Charing Cross Hospital, Fulham Palace Road , London W6 8RF , U.K
| | - Matthew K H Tan
- Academic Section of Vascular Surgery, Department of Surgery and Cancer , Imperial College London , Floor 4 East, Charing Cross Hospital, Fulham Palace Road , London W6 8RF , U.K
| | - Marina Kafeza
- Academic Section of Vascular Surgery, Department of Surgery and Cancer , Imperial College London , Floor 4 East, Charing Cross Hospital, Fulham Palace Road , London W6 8RF , U.K
| | - Richmond T Bergner
- Section of Computational and Systems Medicine, Department of Surgery and Cancer , Imperial College London , Sir Alexander Fleming Building, Prince Consort Road , Kensington, London SW7 2BB , U.K
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer , Imperial College London , Floor 4 East, Charing Cross Hospital, Fulham Palace Road , London W6 8RF , U.K
| | - Elaine Holmes
- Section of Computational and Systems Medicine, Department of Surgery and Cancer , Imperial College London , Sir Alexander Fleming Building, Prince Consort Road , Kensington, London SW7 2BB , U.K.,Health Futures Institute , Murdoch University , Discovery Way , Perth , WA 6150 , Australia
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer , Imperial College London , Floor 4 East, Charing Cross Hospital, Fulham Palace Road , London W6 8RF , U.K
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A variant of the castor zinc finger 1 (CASZ1) gene is differentially associated with the clinical classification of chronic venous disease. Sci Rep 2019; 9:14011. [PMID: 31570750 PMCID: PMC6769056 DOI: 10.1038/s41598-019-50586-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/16/2019] [Indexed: 01/25/2023] Open
Abstract
Recent reports have suggested a reproducible association between the rs11121615 SNP, located within an intron of the castor zinc finger 1 (CASZ1) gene, and varicose veins. This study aimed to determine if this variant is also differentially associated with the various clinical classifications of chronic venous disease (CVD). The rs11121615 SNP was genotyped in two independent cohorts from New Zealand (n = 1876 controls /1606 CVD cases) and the Netherlands (n = 1626/2966). Participants were clinically assessed using well-established CVD criteria. The association between the rs11121615 C-allele and varicose veins was validated in both cohorts. This was strongest in those with higher clinical severity classes and was not significant in those with non-varicose vein CVD. Functional analysis of the rs11121615 variant demonstrated that the risk allele was associated with increased enhancer activity. This study demonstrates that the CASZ1 gene associated C-allele of rs11121615 has a significant, reproducible, association with CVD (CEAP C ≥ 2 meta-odds ratio 1.31, 95% CI 1.27–1.34, P = 1 × 10−98, PHet = 0.25), but not with non-varicose vein (CEAP C1, telangiectasia or reticular veins) forms of venous disease. The effect size of this association therefore appears to be susceptible to influence by phenotypic heterogeneity, particularly if a cohort includes a large number of cases with lower severity CVD.
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Vascular training does matter in the outcomes of saphenous high ligation and stripping. J Vasc Surg Venous Lymphat Disord 2019; 7:732-738. [DOI: 10.1016/j.jvsv.2019.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/19/2019] [Indexed: 01/10/2023]
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Tan MK, Sutanto SA, Onida S, Davies AH. The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 57:851-857. [DOI: 10.1016/j.ejvs.2019.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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Abstract
Chronic venous disease (CVD) is a prevalent condition that tends to worsen with age. Patients initially seek treatment to relieve symptoms of leg pain, discomfort, heaviness and swelling, all of which impact their quality of life. As the disease increases in severity to include varicose veins, skin changes, and venous ulcer, the demand for treatment increases while the quality of life further diminishes. The prevalence of CVD is highest in Western countries where it already consumes up to 2% of healthcare budgets. With the aging of the global population, the prevalences of CVD and severe CVD are projected to increase substantially, foretelling unsustainably large increases in the healthcare resources and costs needed to treat CVD patients in the coming decades. Effective venoactive drug treatments and ablation procedures are available that provide symptom relief, improve quality of life, slow disease progression, and promote ulcer healing. In addition, venoactive drug treatments may be highly cost-effective. However, there is evidence that physician awareness of CVD is suboptimal and that many patients with CVD are not being treated or referred to specialists according to established guidelines. To decrease this treatment gap and prevent unnecessary disease progression, international guidelines are available to help physicians consider CVD treatment options and refer patients when warranted. Improved disease awareness and appropriate early treatment may help reduce the coming burden of CVD.Funding: Servier.
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Affiliation(s)
- Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK.
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40
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Tan MK, Luo R, Onida S, Maccatrozzo S, Davies AH. Venous Leg Ulcer Clinical Practice Guidelines: What is AGREEd? Eur J Vasc Endovasc Surg 2019; 57:121-129. [DOI: 10.1016/j.ejvs.2018.08.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/23/2018] [Indexed: 01/07/2023]
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Tan MKH, Onida S, Laffan M, Davies AH. Thrombophilia in non-thrombotic chronic venous disease of the lower limb - a systematic review. Br J Haematol 2018; 183:703-716. [PMID: 30488425 DOI: 10.1111/bjh.15692] [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: 11/30/2022]
Abstract
Chronic venous disease (CVD) represents a significant healthcare burden. Thrombophilia is proposed as a risk factor, particularly for post-thrombotic CVD. A systematic review was performed to determine the relationship between thrombophilia and non-thrombotic CVD. MEDLINE® and Embase® databases were searched from 1946 up to March 2018. Case-control studies, cohort studies or randomised clinical trials reporting on thrombophilias in non-thrombotic lower limb CVD in adult patients were included. Non-English and post-thrombotic syndrome studies were excluded. Study selection and data extraction were performed by two reviewers. Fifteen studies were included, reporting on 916 cases and 1261 controls. Studies largely focused on venous ulceration and investigated multiple haemostatic factors. An association between thrombophilia and non-thrombotic CVD was identified, with greater prevalence and factor concentration alteration reported in patients compared to controls. Concomitant thrombophilia presence was associated with earlier CVD onset. Relationship strength varied, with commoner aetiologies showing clearer correlation than rarer ones. Thrombophilia is associated with non-thrombotic CVD but the mechanism is unclear and causation cannot be determined. Future research should focus on prospective studies with larger populations and identify adjunct therapies targeting thrombophilia.
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Affiliation(s)
- Matthew K H Tan
- Department of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, UK
| | - Sarah Onida
- Department of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, UK
| | - Michael Laffan
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Alun H Davies
- Department of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, UK
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Ouriel K. Central Venous Pathologies: Treatments and Economic Impact. Methodist Debakey Cardiovasc J 2018; 14:166-172. [PMID: 30410645 DOI: 10.14797/mdcj-14-3-166] [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: 11/08/2022] Open
Abstract
Chronic venous insufficiency (CVI) is responsible for significant costs to society in the form of medical and surgical treatment and, importantly, unmeasurable lost work productivity due to pain and disability. Symptomatic chronic central vein obstruction, a cause of CVI, is potentially treatable using open surgical and endovascular techniques to restore vessel patency. Although upper extremity central vein obstruction often requires an open surgical procedure for durable relief, endovascular stents have proven remarkably useful for iliofemoral disease. Containment of healthcare resources requires accurate diagnosis, durable treatment modalities, and appropriate patient selection so that therapy is targeted to those individuals most likely to benefit. In this regard, identification of appropriate lesions should be based on intravascular ultrasound and 3-dimensional imaging studies. Treatment with dedicated venous stents offers the potential for long-term symptomatic improvement and increased work productivity when used in a well-defined, anatomically appropriate population with significant, symptomatic CVI.
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Mutlak O, Aslam M, Standfield NJ. Chronic venous insufficiency: a new concept to understand pathophysiology at the microvascular level - a pilot study. Perfusion 2018; 34:84-89. [PMID: 30067139 DOI: 10.1177/0267659118791682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The real mechanism for the development of the later stages of chronic venous insufficiency still remains unclear. Venous hypervolemia and microvascular ischemia have been reported to be the consequences of venous insufficiency. The aim of this study was to investigate the effects of induced venous hypovolemia by dorsiflexion exercise in patients with venous leg ulcers. METHODS Thirty-six participants, all of whom had an ankle brachial pressure index between 0.8 and 1.2 mmHg, were chosen for this study. The participants were divided into two groups: Group A, a non-exercise group and Group B which performed regular exercise in the form of dorsiflexion. The basic assessment, including the history and examination, ankle-brachial pressure index (ABPI), Duplex scan and tcPO2 measurements, was performed on two occasions at the beginning of the trial and after three months. RESULTS The tcPO2 level was low in the beginning in all the subjects, but the picture was different at the end of the trial. There was a significant increase in the tcPO2 level (p<0.001) in the patients who performed exercise while there was no difference in the measurements (p>0.05) in the non-exercise group. CONCLUSIONS Induced venous hypovolemia through regular evacuation of the peripheral venous system improved tissue oxygenation at skin level. Venous hypervolemia may be the main contributing factor for the development of venous hypoxia and microvascular ischemia.
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Affiliation(s)
- Omar Mutlak
- Vascular Department, Hammersmith Hospital, Imperial College London, London, UK
| | - Mohammed Aslam
- Vascular Department, Hammersmith Hospital, Imperial College London, London, UK
| | - Nigel J Standfield
- Vascular Department, Hammersmith Hospital, Imperial College London, London, UK
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Khilnani NM, Meissner MH, Vedanatham S, Piazza G, Wasen SM, Lyden S, Schul M, Beckman JA. The evidence supporting treatment of reflux and obstruction in chronic venous disease. J Vasc Surg Venous Lymphat Disord 2018; 5:399-412. [PMID: 28411707 DOI: 10.1016/j.jvsv.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
Abstract
On July 20, 2016, a Medicare Evidence Development and Coverage Advisory Committee panel convened to assess the evidence supporting treatment of chronic venous disease. Several societies addressed the questions posed to the panel. A multidisciplinary coalition, representing nine societies of venous specialists, reviewed the literature and presented a consensus opinion regarding the panel questions. The purpose of this paper is to present our coalition's consensus review of the literature and recommendations for chronic venous disease.
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Affiliation(s)
- Neil M Khilnani
- Division of Interventional Radiology, Weill Cornell Medicine Vein Treatment Center, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY.
| | - Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Suresh Vedanatham
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo
| | - Gregory Piazza
- Vascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Suman M Wasen
- Division of Vascular Medicine, Cardiovascular Section, University of Oklahoma College of Medicine, Oklahoma City, Okla
| | - Sean Lyden
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Joshua A Beckman
- Vascular Medicine, Cardiovascular Division, Vanderbilt University Medical Center, Vanderbilt School of Medicine, Nashville, Tenn
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Staniszewska A, Onida S, Davies AH. Compression therapy for uncomplicated varicose veins - Too little for too much? Phlebology 2018; 34:148-150. [PMID: 29954256 DOI: 10.1177/0268355518781432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Sarah Onida
- 2 Vascular Surgery, Imperial College London, London, UK
| | - Alun H Davies
- 2 Vascular Surgery, Imperial College London, London, UK
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Mansilha A, Sousa J. Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy. Int J Mol Sci 2018; 19:ijms19061669. [PMID: 29874834 PMCID: PMC6032391 DOI: 10.3390/ijms19061669] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022] Open
Abstract
Chronic venous disease (CVD) is a common pathology, with significant physical and psychological impacts for patients and high economic costs for national healthcare systems. Throughout the last decades, several risk factors for this condition have been identified, but only recently, have the roles of inflammation and endothelial dysfunction been properly assessed. Although still incompletely understood, current knowledge of the pathophysiological mechanisms of CVD reveals several potential targets and strategies for therapeutic intervention, some of which are addressable by currently available venoactive drugs. The roles of these drugs in the clinical improvement of venous tone and contractility, reduction of edema and inflammation, as well as in improved microcirculation and venous ulcer healing have been studied extensively, with favorable results reported in the literature. Here, we aim to review these pathophysiological mechanisms and their implications regarding currently available venoactive drug therapies.
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Affiliation(s)
- Armando Mansilha
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
- Departamento de Angiologia e Cirurgia Vascular, Hospital CUF Porto, 4100-180 Porto, Portugal.
| | - Joel Sousa
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
- Departamento de Angiologia e Cirurgia Vascular, Hospital CUF Porto, 4100-180 Porto, Portugal.
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Lorenção de Almeida B, Rossi FH, Guerra de Moraes Rego Sousa A, Kambara AM, Izukawa NM, Beteli CB, Andrade Cavalcante SF, Rodrigues TO, Thorpe PE. Correlation between venous pressure gradients and intravascular ultrasound in the diagnosis of iliac vein compression syndrome. J Vasc Surg Venous Lymphat Disord 2018. [PMID: 29526687 DOI: 10.1016/j.jvsv.2017.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the correlation between venous pressure gradients (VPGs) and intravascular ultrasound (IVUS) for the diagnosis of caval-iliac venous obstructions in patients with advanced chronic venous insufficiency. METHODS Fifty patients with advanced chronic venous insufficiency symptoms (Clinical, Etiology, Anatomy, and Pathophysiology class 3 to 6) were prospectively submitted to multiplanar venography (MV) with intravenous pressure measurements and IVUS. The patients' lower limbs were divided accordingly: group I, limbs with <50% obstruction on IVUS (n = 49); and group II, limbs with ≥50% obstruction on IVUS (n = 51). Receiver operating characteristic curves compared the diagnostic performance of the VPGs. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy assessed the performance of VPGs in categories to determine the presence of significant obstruction. Logistic regression assessed the capacity of the VPGs to identify significant obstruction. RESULTS The most frequent point of venous compression according to IVUS was the proximal left common iliac vein (70%; P < .05). Group II showed a greater prevalence of transpelvic (group I, 8.2%; group II, 74.5%; P < .001) and paravertebral collaterals (group I, 4.1%; group II, 45.1%; P < .001) on MV. The femoral vein pressures at rest and after reactive hyperemia as well as the femorocaval gradient after reactive hyperemia (FCG-rh) and the femoral gradient after reactive hyperemia were significantly higher in group II (P = .001, P < .001, P = .002, and P = .006). The FCG-rh and the femoral gradient after reactive hyperemia presented the best diagnostic performance among the VPGs (P = .004 and P = .007) in the receiver operating characteristic curve analysis, although no significant differences between them were found. All the gradients presented low values of sensitivity (<40%), negative predictive value (<60%), and accuracy (<30%). Logistic regression showed that FCG-rh was significantly independent of MV (OR, 8.1; P = .011) in identifying significant obstructions. CONCLUSIONS There is correlation between the VPGs and significant obstructions with IVUS. However, this correlation does not translate to a good diagnostic performance of these VPGs. Only the FCG-rh added significant information to MV in identifying significant caval-iliac vein obstructions.
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Abstract
SummaryAim: Investigation of symptoms of chronic venous insufficiency (CVI) in geriatric patients > 65 years and their relation to activities of daily life and locomotion.Methods: This monocenter pilot study collects data from patients of a geriatric hospital. We qualified Activities of daily live by Barthel Index, locomotion via Timed-Up-and-Go-test and clinical CEAP levels and included data from the Venous Clinical Severity Score and the patient questionnaire of the German Society of Phlebology. Additionally a duplex-sonographic screening was performed. Identified CEAP levels were correlated with results of the scores mentioned above.Results: 42 patients with an average age of 80.5 (64–93) years were included. 76.2 % of them had a CEAP-score of ≥3. CEAP-score 5-6 correlated with limited locomotion and independence in activities of daily life. 81 % of the patients had previous venous therapies.Conclusion: CVI is an underestimated disease in elder patients. In our collective a great part of patients showed relevant clinical symptoms of CVI which were aggravated by limitations of higher age. Early diagnostic and therapy of CVI are indicated to reduce complicated clinical courses.
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Mitchell A. Assessing the value of practice-based leg ulcer education to inform recommendations for change in practice. Br J Community Nurs 2017; 22:S28-S34. [PMID: 29189067 DOI: 10.12968/bjcn.2017.22.sup12.s28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this paper is to assess the value of accredited leg ulcer education in influencing changes in practice. This is a before and after educational evaluation that adopted a qualitative survey approach of 12 primary care nurses attending the Nurse-Led Assessment and Management of Leg Ulcers accredited CPD module at a London university. The findings revealed that 6 out of the 8 nurses who completed the final interviews were satisfied that all learning outcomes for the module had been met. All of the nurses commented they had changed at least one aspect of practice following the module with the majority stating a number of improvements had been made relating to improved knowledge, practical skills, treatment and patient concordance. The evaluation was limited to a small cohort of primary care nurses and further longitudinal research is required to investigate the effectiveness across multiple cohorts.
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Affiliation(s)
- Aby Mitchell
- Lecturer Health Promotion, Public Health and Primary Care, University of West London
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Avruscio G, Tocco-Tussardi I, Bordignon G, Vindigni V. Implementing clinical process management of vascular wounds in a tertiary facility: impact evaluation of a performance improvement project. Vasc Health Risk Manag 2017; 13:393-401. [PMID: 29081660 PMCID: PMC5652916 DOI: 10.2147/vhrm.s137099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Chronic vascular wounds have a significant economic and social impact on our society calling for allocation of a great deal of attention and resources. Efforts should be oriented toward the achievement of the most effective and efficient clinical management. The Angiology Unit at the University Hospital of Padova, Italy, developed a performance improvement project to enhance the quality of practice for vascular ulcers. Methods The project consisted in a multistep process comprising a critical revision of the previous clinical process management, staff education, tightening connections between operators and services, and creation of a position for a wound care nurse. The previous standard of practice was modified according to the results of revision and the current evidence-based practice. Results The new standard of practice reached its full application in September 2015. The number of patients treated and the number of visits in 2015 remained almost unvaried from 2014. However, the total annual expenditure for treating vascular ulcers was reduced by ~60% from the previous year. Conclusion Standardization of guidelines and practice is effective in creating an efficient clinical management and in reducing the economic burden of vascular ulcers.
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Affiliation(s)
- Giampiero Avruscio
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Ilaria Tocco-Tussardi
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy.,Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University Hospital of Padova, Padova, Italy
| | - Greta Bordignon
- Clinical Management, University Hospital of Padova, Padova, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University Hospital of Padova, Padova, Italy
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