Diagnosis and management of venous leg ulcers

Lim, Chung Sim; Baruah, Moushumi; Bahia, Sandeep S.

doi:10.1136/bmj.k3115

Cited by 35 publications

(41 citation statements)

References 60 publications

(85 reference statements)

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“…Other pathophysiology of venous return and of venous ulcer development is proposed, including inadequate microorganisms’ colonization, iceberg hypothesis of chronic venous insufficiency, and venous hypoxia in the microcirculation in the skin level [ 1 , 7 , 8 , 9 ]. However, other etiologies of unhealed leg ulcers are not easily differentiated according to conventional venous evaluation [ 1 , 3 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging

et al. 2020

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Objectives: The distribution of venous pathology in stasis leg ulcers is unclear. The main reason for this uncertainty is the lack of objective diagnostic tools. To fill this gap, we assessed the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in determining the venous status of patients with stasis leg ulcers. Methods: This prospective observational study included the data of 23 patients with stasis leg ulcers who underwent TRANCE-MRI between April 2017 and May 2020; the data were retrospectively analyzed. TRANCE MRI utilizes differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing not only a venogram but also an arteriogram without the use of contrast agents or radiation. Results: TRANCE MRI revealed that the stasis leg ulcers of nine of the 23 patients could be attributed to valvular insufficiency and venous occlusion (including deep venous thrombosis [DVT], May–Thurner syndrome, and other external compression). Moreover, TRANCE MRI demonstrated no venous pathology in five patients (21.7%). We analyzed TRANCE MRI hemodynamic parameters, namely stroke volume, forward flow volume, backward flow volume, regurgitant fraction, absolute volume, mean flux, stroke distance, and mean velocity, in the external iliac vein, femoral vein, popliteal vein, and great saphenous vein (GSV) in three of the patients with valvular insufficiency and three of those with venous occlusion. We found that the mean velocity and stroke volume in the GSV was higher than that in the popliteal vein in all patients with venous valvular insufficiency. Conclusions: Stasis leg ulcers may have no underlying venous disease and could be confirmed by TRANCE-MRI. TRANCE MRI has good Interrater reliability between Duplex study in greater saphenous venous insufficiency. It also potentially surpasses existing diagnostic modalities in terms of distinguishable hemodynamic figures. Accordingly, TRANCE-MRI is a safe and useful tool for examining stasis leg ulcers and is extensively applied currently.

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Section: Discussionmentioning

confidence: 99%

“…The wounds are usually limited to the subcutaneous plane; however, secondary infection can destroy deep soft tissue. By contrast, leg wounds due to arterial occlusive disease are characterized by rapid progression with a high incidence of limb loss [ 1 , 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging

et al. 2020

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“…3 Initial treatment usually involves compression stockings, although their use is limited by frailty, obesity, and skin fragility or contact dermatitis. 4,5 If the condition worsens, minimally invasive procedures, such as subfascial endoscopic perforator surgery 6 or endovenous laser ablation 7 are used. If these procedures are ineffective, drug therapy, such as pentoxifylline, 8 and surgeries, including high ligation and stripping of the great saphenous vein, are performed.…”

Section: Discussionmentioning

confidence: 99%

Varicose vein on right tibia, post-traumatic varicose ulcer, and bone exposure: A case report

Qin

Wang

et al. 2020

SAGE Open Medical Case Reports

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Varicose ulcer, a severe symptom of chronic venous insufficiency, may be refractory to treatment when accompanied by bone exposure. The lack of a blood supply and fresh granulation tissue on the exposed bone can result in a protracted healing time. A 59-year-old man suffered from varicose veins for 10 years, a varicose ulcer for 1 year, and an exposed right tibia for 40 days after using traditional Chinese medicinal plasters. The patient was treated with conventional high ligation and stripping of the great saphenous vein, segmental endovenous laser ablation, bone drilling, and a free skin graft. Patient outcome is satisfactory 2 years after discharge. We present a rare case of varicose ulcer in association with bone exposure. Tibia drilling with Kirschner wire was used to allow blood flow and provide nutrients for the formation of granulation tissue over the exposed bone and wound healing. Subsequently, free skin grafting was used during reconstructive surgery to replace skin loss on the right calf. Physicians encountering this rare condition in clinical practice should consider our treatment approach as a successful limb-preserving option for these patients.

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“…Stiff arteries found in diabetes may not compress on ankle:brachial pressure index (ABPI) measurement producing falsely reassuring high readings. People with diabetes and leg ulcers should be assessed in a specialist diabetes foot and ulcer service which should supervise management …”

Section: Foot and Leg Diseasementioning

confidence: 99%

Veins, venous thromboembolism, and diabetes

Hillson

2019

Practical Diabetes

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Diagnosis and management of venous leg ulcers

Cited by 35 publications

References 60 publications

Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging

Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging

Varicose vein on right tibia, post-traumatic varicose ulcer, and bone exposure: A case report

Veins, venous thromboembolism, and diabetes

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