A Review of the Current Management and Treatment Options for Superficial Venous Insufficiency

Zhan, Henry; Bush, Ruth L.

doi:10.1007/s00268-014-2621-0

Cited by 13 publications

(4 citation statements)

References 68 publications

(83 reference statements)

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“…Using a higher-pressure compression stocking could have led to arterial complications. In addition, the act of leg elevation while sleeping was an additional aid alleviate the venous insufficiency [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Improvement of Ulcerations in Treatment-Resistant Chronic Scarring in a Patient with Pyoderma Gangrenosum After Improving Vascular Insufficiency, Gently Removing Necrotic Debris, and Decreasing Wound Fluid

et al. 2018

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Patient: Male, 44Final Diagnosis: Pyoderma gangrenosumSymptoms: Pain • ulceration • scarring • exudate • necrosisMedication: Clobetasol 0.5% ointment • Cadexomer iodine • PentoxifyllineClinical Procedure: Compression stocking application • leg elevation at nightSpecialty: Family MedicineObjective:Rare diseaseBackground:Classical pyoderma gangrenosum is a rare, inflammatory, neutrophilic dermatosis that commonly presents with severe ulcerations on the lower extremities and is often misdiagnosed and mistreated. Delay in treatments can lead to worsening of the ulcerations and allows for multiple comorbid factors. Pyoderma gangrenosum is most commonly treated with immunosuppressants or anti-inflammatory agents and is often worsened by surgical procedures due to the presence of pathergy. In acute cases, a course of anti-inflammatory treatments works well in alleviating symptoms and reducing ulcerations and residual scarring. However, in chronic cases with the presence of severe scarring and necrotic ulcerations, the simple implementation of systemic immunosuppressants is frequently ineffective alone. Although not mentioned in most case reports on pyoderma gangrenosum, the chronicity of its inflammatory component can lead to necrosis and scarring and subsequent vascular insufficiency.Case Report:We present a severe case of chronic ulcerative pyoderma gangrenosum in a patient who had treatment-resistant ulcerations and cribriform edematous scarring with subsequent vascular insufficiency of the right lower extremity. This patient, while receiving topical clobetasol, had marked improvement in the healing of his ulcerations only after starting a novel course of cadexomer iodine, compression stockings, and pentoxifylline.Conclusions:The efficacy of non-anti-inflammatory treatments indicates that chronic pyoderma gangrenosum with extensive scarring is commonly associated with the comorbid factors of vascular insufficiency, necrotic debris, and extensive wound fluid. In cases of ulcerations in chronic pyoderma gangrenosum that are resistant to anti-inflammatory treatments alone, one should identify and address other compounding factors that may inhibit wound healing.

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Section: Discussionmentioning

confidence: 99%

Improvement of Ulcerations in Treatment-Resistant Chronic Scarring in a Patient with Pyoderma Gangrenosum After Improving Vascular Insufficiency, Gently Removing Necrotic Debris, and Decreasing Wound Fluid

et al. 2018

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“…Phlebectomy (also known as microphlebectomy or stab avulsion) is used to target bulging varicose veins closer to the surface of the skin. This technique is highly recommended for tortuous distal varicosities and offers improved cosmetic results and decreased risk of blood clots [ 157 ]. Phlebectomy may be performed via a conventional multiple stab technique; recently, however, transilluminated powered phlebectomy (TIPP), in which transillumination is used to guide mechanical vein avulsion following hydrodissection using tumescent anesthesia, has gained popularity due to its minimally invasive nature and ease of use.…”

Section: Advances In Surgical Managementmentioning

confidence: 99%

Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review

Orhurhu

Chu²,

Xie

et al. 2021

Cardiol Ther

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Purpose of Review: Chronic venous insufficiency is found to some extent in a large proportion of the world's population, especially in the elderly and obese. Despite its prevalence, little research has been pursued into this pathology when compared to similarly common conditions. Pain is often the presenting symptom of chronic venous insufficiency and has significant deleterious effects on quality of life. This manuscript will describe the development of pain in chronic venous insufficiency, and will also review both traditional methods of pain management and novel advances in both medical and surgical therapy for this disease. Recent Findings: Pain in chronic venous insufficiency is a common complication which remains poorly correlated in recent studies with the clinically observable extent of disease. Although lifestyle modification remains the foundation of treatment for pain associated

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“…However, large varicose veins require additional procedures such as ambulatory phlebectomy or stab avulsion. 6 Direct varicose ablation is not common in general practice. A study by Park et al, published in 2007, suggested that direct laser ablation couldn't replace classic methods for treating branch varicosities because of the high failure rate and risk of burned skin.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Successful results of direct varicose vein ablation with EVLA in chronic venous insufficiency patient in Indonesia

Siddiq¹,

Utoh²,

Dakota³

et al. 2023

F1000Res

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Background: Varicose veins are considered a chronic venous disease. Delaying treatment might cause several late complications that contribute to a high burden on healthcare systems. It may be treated with endovenous laser ablation (EVLA) and stab avulsion as additional procedures. Varicose direct ablation has been promoted to replace stab avulsion in certain conditions. Here we report the case of a 71-year-old female who presented with chronic venous insufficiency managed by an endovascular therapeutic approach using direct varix ablation for the first time in National Cardiovascular Center – Harapan Kita, Jakarta, Indonesia. Case report: A 71-year-old female came to the outpatient clinic with a large bulging vein in her leg. Duplex ultrasound showed that the great saphenous vein (GSV) was incompetent with a varicose vein in the medial part of proximal GSV below the knee. The patient underwent EVLA with direct varicose ablation using Utoh’s technique. Duplex sonography evaluation showed the right GSV was utterly obliterated, including the varicose vein. The patient was discharged two days after the procedure without significant complaints nor pain medication. Conclusions: Direct varicose ablation was proposed as a better alternative than stab avulsion. The varicose vein can be managed with EVLA without a scalpel, incision, avulsion, or phlebectomy. In this case presentation, the endovascular therapeutical approach with Utoh’s ablation technique showed promising results, and no complication was found in the patient.

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A Review of the Current Management and Treatment Options for Superficial Venous Insufficiency

Cited by 13 publications

References 68 publications

Improvement of Ulcerations in Treatment-Resistant Chronic Scarring in a Patient with Pyoderma Gangrenosum After Improving Vascular Insufficiency, Gently Removing Necrotic Debris, and Decreasing Wound Fluid

Improvement of Ulcerations in Treatment-Resistant Chronic Scarring in a Patient with Pyoderma Gangrenosum After Improving Vascular Insufficiency, Gently Removing Necrotic Debris, and Decreasing Wound Fluid

Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review

Case Report: Successful results of direct varicose vein ablation with EVLA in chronic venous insufficiency patient in Indonesia

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