Stages Of Chronic Venous Insufficiency Research Articles

Pigmentation of lower limbs: Contribution of haemosiderin and melanin in chronic venous insufficiency and related disorders.

To determine the composition of skin pigmentation in chronic venous insufficiency (CVI) and other less common vascular conditions of lower limbs. Forty-five skin biopsies were obtained from 17 patients. Samples were taken from pigmented regions and compared with control non-lesional samples from the same patient. Perl's Prussian Blue was used to identify haemosiderin and Schmorl's for melanin. Seven patients presented with CVI, one with concurrent livedo vasculopathy (LV). One patient had LV only. Two patients had acroangiodermatitis (AAD). Six patients had post-sclerotherapy pigmentation (PSP), one with concurrent post-inflammatory hyperpigmentation (PIH). One patient had PIH only. The predominant pigment in CVI samples was haemosiderin. C5-C6 patients showed increased epidermal melanin. LV, AAD, and PSP samples showed dermal haemosiderin but no increase in epidermal melanin. PIH samples showed prominent epidermal melanin whilst no haemosiderin was detected. The predominant pigment in CVI and other vascular conditions was haemosiderin. Melanin was present in later stages of CVI (C5-C6) and in PIH.

African Americans Have the Worse Stage of Chronic Venous Insufficiency at the Time of Ablation Therapy for Superficial Venous Disease With Least Postprocedural Improvement

African Americans Have the Worse Stage of Chronic Venous Insufficiency at the Time of Ablation Therapy for Superficial Venous Disease With Least Postprocedural Improvement

Association between cardiac conditions with venous leg ulcers in patients with chronic venous insufficiency

Venous leg ulcers (VLUs) are the final stage of chronic venous insufficiency. This study aims to characterize the association between cardiovascular diseases and VLU. A multicentric case-control study analyzed 17,788 patients between 2015 and 2020. Cases were matched (1:2) by age and sex, and odds ratios (OR) were analyzed with conditional logistic regressions adjusted by risk factors. The prevalence of VLU was 15.2%. 2390 cases were analyzed. Diseases found to be associated with VLU were atrial fibrillation (OR, 1.21; 95% CI: 1.03-1.42), pulmonary hypertension (OR, 1.45; 95% CI: 1.06-2.00), right heart failure (OR, 1.27; 95% CI: 1.13-1.43), peripheral artery disease (OR, 2.21; 95% CI: 1.90-2.56), and history of pulmonary embolism (OR, 1.45; 95% CI: 1.06-2.00). Certain cardiovascular conditions showed an association with VLU. Further studies are warranted to evaluate the effect that treating concomitant cardiovascular diseases might exert on the natural history of venous leg ulcers.

Ulcus cruris venosum

The article presents the definition of venous ulcers as the terminal stage of chronic venous insufficiency. The medical, socioeconomic, and epidemiological significance of this disease is discussed. The theories of the origin of venous ulcerations are presented, as well as original etiopathogenic concepts. It has been found that there are two types of venous ulcers caused by surface and perforator insufficiency (which are less extensive and have satisfactory therapeutic results), and ulcers due to reflux or obstruction of the deep system (which are accompanied by more severe microcirculatory and tissue changes and are refractory to most known therapeutic agents). The use of individual therapeutic modalities is presented (local and general measures, compression bandaging, and medicamentous and surgical therapy). Data on the results and indications for surgical treatment are also presented (crossectomy, stripping of surface trees, ligation and other procedures on insufficient perforators, saphenopopliteal anastomosis, femoro-femoral crossover anastomosis, interposition of venous trees, and other interventions on deep veins). The immediate and remote results of treatment depend on the etiological assessment of the disease and precise indication criteria.

Concentrations of selected acute phase proteins in patients with chronic venous insufficiency treated with Sulodexide. Part 1.

Chronic venous insufficiency (CVI) is a widespread and serious social problem. The pathogenesis of the disease is multifactorial and one of the important factors in its development is inflammation. Assessment of the concentration of selected acute phase proteins: C-reactive protein (CRP) and α1 antitrypsin (AAT) in the blood serum of patients with CVI before and after treatment with Sulodexide. The study was carried out in 88 people, including 39 clinically healthy subjects as the reference group and 49 patients with CVI at various stages of the disease. The concentrations of CRP and AAT were determined. The concentration of CRP in patients before the use of Sulodexide, compared to the results in the reference group, was statistically significantly higher. The concentration decreased significantly after the applied treatment. AAT concentration was significantly (p < 0.05) higher in the group of patients compared to the reference group. After treatment with Sulodexide, AAT concentration decreased in all study groups, which was statistically significant compared to the reference group. Elevated levels of acute phase proteins: CRP and AAT in patients indicate the participation of the inflammatory component in the pathogenesis of CVI. Monitoring levels of acute phase protein, especially AAT, may be useful in tracking the course of the disease, the body's response to treatment, and in making prognosis. Sulodexide, which acts mainly as an anticoagulant and profibrinolytic, also has an anti-inflammatory effect, which may contribute to the inhibition of the development of subsequent stages of CVI.

VENÖZ REFLÜSÜ OLAN VE OLMAYAN, KRONİK VENÖZ HASTALIK TANILI BİREYLERDE MANUEL LENF DRENAJININ LOKAL DOKUDAKİ SU ORANLARI VE YAŞAM KALİTESİ ÜZERİNE ETKİLERİ: PİLOT ÇALIŞMA

Background: Manual Lymphatic Drainage (MLD) is an alternative treatment approach that can be used in patients with a diagnosis of Chronic Venous Insufficiency (CVI). This study aimed to examine the effects of MLD on local tissue water and quality of life (QoL) in CVI patients. Methods: Ten patients were included in the study. The patients with venous reflux greater than 0.5 seconds enrolled in the CVI group, and individuals without venous reflux were categorized as the Chronic Venous Disease (CVD) group. The water percentages in the local tissue were measured with the MoistureMeterD Compact device. QoL was assessed with the Venous Insufficiency Epidemiologic and Economic Study Quality-of-Life Questionnaire (VEINES-QOL/Sym). Results: Symptom score increased from 32.60±5.68 to 36.40±6.95, and total QoL score increased from 51.8±5.89 to 55.6±5.32 significantly in patients with CVD. Symptom score increased from 29.00±5.96 to 34.00±6.12, and total QoL score increased from 47.20±8.58 to 52.00±5.96 significantly in patients with CVI. No more significant improvement in quality of life in either CVI or CVD group (p&amp;gt;0.05). MLD has an effect on the water absorption from the local tissue in the CVD although this decrease was not statistically significant, and it was insufficient in the CVI stage (p&amp;gt;0.05). Conclusion: It was thought that MLD could provide relief in the symptoms and an improvement in QoL, independent of the presence of venous reflux. In future studies, the change in the local tissue water with MLD should be examined in patients with CVI with a larger number of patients.

Modern technologies of venous ulcers treatment in elderly population

Venous trophic ulcers take place in the terminal stage of chronic venous insufficiency. The problem of venous trophic disorders is extremely relevant due to the high prevalence among the population. This review considers the comparative characteristics of morbidity data on the example of Germany and the Russian Federation. Particular attention paid to the influence of the course of the disease on patient’s life quality during treatment. The causes of high-cost treatment are reported with approximate calculations for 1 clinical case and total annual costs according to foreign researchers (Australia, Great Britain, USA). The risk factors are discussed in the form of certain concomitant nosologies that significantly aggravate the healing process of ulcers with a brief description of the pathogenesis. The review defines the main goals of the treatment of venous trophic ulcers, as well as separate groups of directions in which it is reasonable to carry out therapeutic measures. Article presents a comparative analysis between the methods of applying compression therapy (elastic bandaging, the use of special stockings) and the influence of the choice on the quality of life of patients. Various methods of topical wound care are described with the obligatory consideration of the stage of the wound process, alternative methods of local treatment are listed (for example, the use of autologous platelet-rich plasma). The efficacy of systemic pharmacotherapy in trophic disorders and the treatment potential of various groups of drugs on the rate of ulcer healing were evaluated. The advantages of using surgical treatment are determined, the main surgical techniques are listed, highlighting the advantages and disadvantages of each. Possible treatment strategies for elderly patients also discussed. The complexity of evaluating the effectiveness of new techniques and an integrated approach to treatment is shown, which in the future will help to correct the direction of finding new ways to solve the problem of venous ulcers in this specific group of patients.

The role of the anatomical structure of the lymphatic system of lower limbs in the development of chronic venous edema in varicose veins disease

Introduction. Varicose veins disease of the lower extremities is often accompanied by edema, which persists even after the elimination of the causes of venous insufficiency. Clinically, the etiopathogenesis of edema in such patients is not always possible to differentiate. Objective. To determine the role of the lower limb lymphatic vasculature stucture variants in the development of chronic venous edema in patients with varicose veins disease. Materials and methods. A retrospective analysis of the results of X-ray contrast lymphography and radionuclide lymphoscintigraphy of 257 patients with different stages of chronic venous insufficiency (CVI). Results. Pathognomonic patterns of the lymphatic vasculature structure at various stages of lymphedema in patients with C3-C5 CVI were discovered. We found that the increasing number of cases of persistent oedema could be associated with the lower limb lymphatic vasculature hypoplasia and higher classes of CVI: 43.95 % among the patients with C4 CVI and 88 % with C5 CVI. The majority (94,1 %) of patients with C3 CVI with a normal-like lymphatic system presented with transitory oedema. With CVI C5, the capacity of the groin lymph nodes was impaired in 64 %. In C4 CVI, weak contrasting was observed in 45.1 %. With C3 – in 35.1 % of cases. Conclusions. The progressing degree of chronic venous oedema could be associated with the lymphatic vasculature hypoplasia and the malfunction of the groin lymph nodes.

Current indications for phlebotropic therapy and its duration

Phlebotropic therapy is an important component of the pathogenetic treatment of chronic venous insufficiency (CVI) of the lower extremities. Venoactive drugs, which have proven their effectiveness and safety in a variety of studies, are widely represented in international and Russian clinical guidelines and standards. However, there is no consensus on the regulation of phlebotropic therapy and, above all, its duration in different clinical classes of CVI. In addition, there are no clear indications on the methods of treatment efficacy monitoring, which can be used in real clinical practice. The presented systematized review of the literature data on micronized purified flavonoid fraction not only reveals the possibilities of phlebotropic therapy of different clinical classes and forms of CVI, but also suggests effective regulations for the use of this drug in specific situations. The data concerning the efficacy of phlebotropic therapy in real clinical practice at the initial stages of CVI (C0s-C1s), in the treatment of C2s (varicose superficial veins with venospecific symptoms), C3 (chronic venous edema), C4 (trophic skin disorders), as well as in stages C5-C6 and C6r (venous trophic ulcers) are presented in details. In addition, the results of studies on the use of micronized purified flavonoid fraction in phlebosclerosing treatment are presented. The duration of phlebotropic therapy is in direct relation to the severity of the disease and the response to the ongoing treatment. The important role is played not only by personalization of treatment according to specific symptoms and syndromes, but also, if possible, by objective control of their dynamics.

Pleiotropic therapy for the initial stages of chronic venous insufficiency in post-thrombotic disease

Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p &lt;0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p &lt; 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p &lt; 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p &lt; 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p &lt; 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p &lt; 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p &lt; 0.05).Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.

Modern view on the therapy of chronic venous insufficiency with micronized purified flavonoid fraction

The high prevalence of varicose veins has been established in numerous population studies. Currently, guidelines have been developed for the treatment of patients with varicose veins for various stages of chronic venous insufficiency. Nevertheless, despite the use of modern drugs, leg compression, surgical and other interventions, it is not possible to completely reverse the symptoms of venous insufficiency. The article is devoted to the analysis of micronized flavonoid purified fraction. The development of modern drugs for chronic venous diseases is an important direction in medicine. The creation of a drug pool manufactured InRussiais a priority in the development of the country’s pharmaceutical industry. The review presents data on the study of Detravenol (Russia), which is a combination of diosmin and hesperidin (micronized purified flavonoid fraction).

Sulodexide in the Treatment of Chronic Venous Insufficiency: Results of the All-Russian Multicenter ACVEDUCT Program

Sulodexide was a safe and effective medication in the treatment of a cohort of patients with lower extremity chronic venous insufficiency (CVI). This multicenter prospective observational Russian study enrolled 2263 patients with various stages of CVI, mainly classes C3 and C4, who were routinely prescribed sulodexide. Symptom improvement was seen in 56.4%, and 42.8% reported a decreased number of symptoms, mainly after about 2 weeks of treatment and in those aged 30 to 40 years. Sulodexide, used in many countries outside the United States, is a mixture of glycosaminoglycans extracted from porcine intestinal mucosa including low-molecular-weight heparin and dermatan sulfate. It is a lipid-lowering, antithrombotic, and anti-inflammatory agent, decreasing viscosity. It has been used for the management of venous disease and venous ulcerations and for the prevention of recurrent thromboembolism. There are reports of efficacy in advanced stages of CVI, but not routine use. This study overestimates the effectiveness of this drug, adding the results and stating that 99.2% (56.4% plus 42.8%) of patients had improvements. High-quality data are needed.

Chronic Venous Insufficiency and Post-thrombotic Syndrome; Approach to Management and Health Resort Treatment

Introduction: Post- thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT), and develops in 20–50% of patients after a proximal DVT. Balneotherapy and hydrotherapy is justified in treatment of primary or post-thrombotic chronic venous insufficiency (CVI). M aterial: A review of articles was done in electronic databases Pubmed and Medline by keywords: postthrombotic syndrome, chronic venous insufficiency in conjunction with balneotherapy, hydrotherapy, kinesitherapy, coagulation. Results: Main risk of PST is considered as extensive proximal character of DVT, pre-existing CVI, older age, high body mass index, pre-existent varicosities. PTS refers to clinical manifestations of CVI, and is common cause of unilateral CVI. The thrombus itself may lead to venous valves destruction and reflux. The Villalta PTS scale may define and classify the severity of PTS Venous leg ulcers is the most advanced clinical manifestation of the disease. Prevention of PTS begins with prevention of initial and recurrent DVT includes use of compression stockings and anticoagulant medications. Treatment guidelines recommend anticoagulant therapy - five days with heparin followed by three months of oral anticoagulant after acute event, with subsequent long-term of extended therapy depending on patient’s risk of recurrence. Recent clinical trials indicate that the use of new anticoagulants (NOAS) reduces the incidence of PTS. Ultrasound compression test of the leg veins evaluates the degree of obstruction by clots. Medical therapy of CVI has still not efficient. Carbon dioxide baths and ozone baths have favorably affect hemostasis system. However there are only a few controlled studies evaluating effects of balneotherapy in primary and post-thrombotic CVI. The favorable effect of these mineral baths may result from both hydrostatic effects as well as the contribution with specific chemico-physical properties. The controlled trials (in patients with C3 -C5 stage) shown that balneohydrotherapy and kinesitherapy have decreased signs and symptoms in patients with primary and post - thrombotic CVI. Conclusions: The Health Resort treatment of patients with CVI in the mechanism of post-thrombotic syndrome should be preceded by evaluation of the venous system of the lower limb by compression ultrasound. Balneotherapy and hydroteraphy seem to be effective and safe procedures even in patients with advanced primary and post-thrombotic CVI stage.

Effects of the use of bioceramic wraps in patients with lower limb venous ulcers: A randomized double-blind placebo-controlled trial

BackgroundVenous ulcer represents the most advanced stage of chronic venous insufficiency. It is an important public health problem and has a significant impact on patients’ quality of life due to chronic pain, inability to work, need for hospitalization and frequent outpatient follow-up. ObjectiveWe investigated the treatment benefits of far-infrared ceramic (cFIR), in a 90-day study of lower limb venous ulcers and looked at ulcer healing scores, quality of life, serum bio-markers of oxidative stress and antioxidant defense enzymes. Design, setting, participants and interventionsThis is a randomized double-blind placebo-controlled study conducted in the Vascular Surgery Service of a hospital located in the northwest region of the State of Rio Grande do Sul, Brazil. We included patients with lower limb venous ulcers who were randomized to use either a bioceramics wrap or a placebo wrap for 90 days. Main outcome measuresThe following evaluations were conducted at baseline and after 15, 30, 60 and 90 days: ulcer healing score, quality of life, and serum markers of oxidative stress and antioxidant enzyme activity. ResultsPatients (n = 24) with lower limb venous ulcers were randomized into two treatment groups. cFIR decreased the ulcer size on day 30 (P = 0.042) and 90 (P = 0.034) and the total ulcer healing scale scores on day 30 (P = 0.049) and 90 (P = 0.02) of the treatment, when compared to baseline. Additionally, cFIR improved tissue type (epithelial tissue) on day 60 (P = 0.022) when compared to baseline evaluation. ConclusioncFIR clinically improved ulcer healing in patients with lower limb venous ulcers. Trial registrationRBR-8c7xzn on ReBEC.

Therapeutic compression materials and wound dressings for chronic venous insufficiency: A comprehensive review.

Chronic venous insufficiency (CVI) is a common disorder worldwide. Related pathophysiological mechanisms reportedly involve venous pooling and reduced venous return, leading to heaviness, aching, itchiness, tiredness, varicosities, pigmentation, and even lower limb ulceration. Approaches adopted to manage CVI at various stages of clinical-etiology-anatomy-pathophysiology include compression therapy, pharmacological treatment, ultrasound treatment, surgery, electrical or wireless microcurrent stimulation, and pulsed electromagnetic treatment. Among these, polymer-based therapeutic compression materials and wound dressings play increasingly key roles in treating all stages of CVI because of their unique physical, mechanical, chemical, and biological functions. However, the characteristics, working mechanisms, and effectiveness of these CVI treatment materials are not comprehensively understood. The present systematic review examines the structures, properties, types, and applications of various polymer-based compression materials and wound dressings used in prophylaxis and treatment of CVI. Existing problems, limitations, and future trends of CVI treatment materials are also discussed. This review could contribute to the design and application of new functional polymer materials and dressings to enhance the efficiency of CVI treatments, thereby facilitating patients' self-care ability and long-term health improvement.

Clinical progress of wound management in venous leg ulcers

Venous leg ulcer (VLU) is a disease of venous hypertension leading to open skin lesions of lower extremities, which is the terminal stage of chronic venous insufficiency. Considering the high prevalence and recurrence rate, VLU restrain daily activities, impair mental health and even contribute to social isolation of patients. Currently, surgery and compression therapy are wildly used to relieve symptoms and eliminate the etiological factors, however, ulcers remain unhealed even after these treatments in many cases. In this article, we review the clinical progress of treatment for VLU, including the debridement, antibiotics, ulcer dressing, negative pressure wound therapy and skin graft, to provide reference on the therapeutic strategy for different ulcer conditions. Key words: Varicose ulcer; Wound healing

Chronic venous insufficiency: a new concept to understand pathophysiology at the microvascular level - a pilot study.

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. 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. 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. 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.

Pharmacotherapy of chronic venous insufficiency of the lower extremities

Chronic venous insufficiency (CVI) is the most common pathology of the peripheral vascular system. One of the main principles of conservative treatment for both small and complicated forms is pharmacotherapy with the use of venoactive drugs. The effectiveness of therapy is largely associated with the choice of phlebotrophic drug. The article discusses approaches to systemic and topical drug therapy depending on the form and stage of CVI.

Medical compression stockings reduce hypertension of nailfold capillaries at the toe of patients with chronic venous insufficiency1.

The simulated calf-muscle contraction induced a steep increase of CP with 5.65 mmHg/s (Q1 5.27 mmHg/s, Q3 5.92 mmHg/s), which was significantly (p = 0.013) reduced by MCS to 2.47 mmHg/s (Q1 1.65 mmHg/s, Q3 3.0 mmHg/s). Time needed to reach the max. CP was 11.35 s, which was lengthened by MCS to 23.4 s (p = 0.134). Compression therapy prevents capillary hypertension, the major hemodynamic reason for the development of advanced stages of chronic venous insufficiency which are defined by skin disease like hyperpigmentation, lipodermatosclerosis and ulcer.

Plasma concentration of selected biochemical markers of endothelial dysfunction in women with various severity of chronic venous insufficiency (CVI)-A pilot study.

BackgroundAlthough the endothelial dysfunction is considered to be implicated in the pathogenesis of chronic venous insufficiency (CVI) the endothelial status in patients with venous disorders is still not fully evaluated. Therefore the aim of the study was to measure the concentration of selected markers of endothelial dysfunction: von Willebrand factor (vWf), soluble P-selectin (sP-selectin), soluble thrombomodulin (sTM) and soluble VE-cadherin (sVE-cadherin) in CVI women who constitute the most numerous group of patients suffering from venous disease.Materials and methodsForty four women with CVI were involved in the study and divided into subgroups based on CEAP classification. Concentration of vWf, sP-selectin, sTM and sVE-cadherin were measured and compared with those obtained in 25 healthy age and sex-matched women.ResultsIt was found that the concentration of sTM increased and sVEcadherin decreased along with disease severity in CVI women. A significant rise of sTM was observed especially in CVI women, with the highest inflammation status reflected by hsCRP or elastase concentration, and in CVI women with a high oxidative stress manifested by an increased plasma MDA. A significant fall of circulating sVE-cadherin was reported in CVI women with moderate to highest intensity of inflammation and oxidative stress. There was no change in vWF and sP-selectin concentration at any stage of CVI severity.ConclusionsThe results of the present study demonstrate the presence of endothelial dysfunction in women suffering from CVI which seems to progress with the disease severity and may be associated with inflammation and enhanced oxidative stress.