Healing rates following venous surgery for chronic venous leg ulcers in an independent specialist vein unit

Thomas, C Acevedo; Holdstock, Judy M; Harrison, CC; Price, B. A.; Whiteley, Mark S

doi:10.1258/phleb.2012.011097

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…In some of the older RCTs, such as ESCHAR, many patients in the interventional arm either did not have surgery or underwent procedures that would be considered suboptimal by modern endovenous standards33. The model assumes patients are maintained on lifetime compression therapy after interventional procedures to avoid recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The model assumes patients are maintained on lifetime compression therapy after interventional procedures to avoid recurrence. It has been suggested33 that some patients could be managed successfully without compression after interventional procedures. However, these considerations would make interventional procedures even more cost‐effective than compression alone.…”

Section: Discussionmentioning

confidence: 99%

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Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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BackgroundVenous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost‐effectiveness of interventional procedures alongside compression therapy versus compression therapy alone for the treatment of chronic venous leg ulceration.MethodsA Markov decision analytical model was developed. The main outcome measures were quality‐adjusted life‐years (QALYs) and lifetime costs per patient, from the perspective of the UK National Health Service at 2015 prices. Resource use included the initial procedures, compression therapy, primary care and outpatient consultations. The interventional procedures included superficial venous surgery, endothermal ablation and ultrasound‐guided foam sclerotherapy (UGFS). The study population was patients with a chronic venous ulcer who were eligible for either compression therapy or an interventional procedure. Data were obtained from systematic review and meta‐analysis of RCTs.ResultsSurgery gained 0·112 (95 per cent c.i. −0·011 to 0·213) QALYs compared with compression therapy alone, with a difference in lifetime costs of €−1330 (−3570 to 1262). Given the expected savings in community care, the procedure would pay for itself within 4 years. There was insufficient evidence regarding endothermal ablation and UGFS to draw conclusions.DiscussionThis modelling study found surgery to be more effective and less costly than compression therapy alone. Further RCT evidence is required for both endothermal ablation and UGFS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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“…Conversely, coexisting non-venous vascular pathologies contributed to delayed healing. Ulcers of mixed arterio-venous aetiology [10,11,19,28,29] and those presenting with clinically relevant lymphedema [30] were less likely to heal. Also, a pathological functioning of the muscle pump resulted in decreased healing rates.…”

Section: Healing Of Venous Leg Ulcers -Prognostic Factorsmentioning

confidence: 98%

Prognostic factors for delayed healing of venous leg ulcers

Simka¹

2014

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Risk factors of poor healing of venous leg ulcers can be categorised into three main groups: those related to the ulcer, those related to the patient, and those related to the organisation of wound care. Identification of risk factors that predispose these patients to prolonged wound healing not only offers an opportunity to determine their clinical outcome, but can also be linked to the decision regarding alternative interventions or even reorganisation of the wound care. Factors related to the ulcer comprise large ulcer size and long ulcer duration. Also, some macroscopic features of venous leg ulcers are associated with delayed healing: fibrin covering more than 50% of the area of the wound and highly exuding ulcers. Coexisting non-venous vascular pathologies, such as arterial ischaemia or clinically relevant lymphedema, as well as history of deep vein thrombosis, can contribute to delayed healing. Additionally, pathological functioning of calf muscle pump can be associated with reduced healing. Some bacterium species seem to interfere with healing of venous leg ulcers, especially if the number of such microorganisms in the wound bed is high. Regarding patient characteristics, reduced mobility (patients being chair or bedbound) is a risk factor, while it remains unclear whether the demographic characteristics of the patients or their non-vascular co-morbidities are really associated with impaired healing. In addition, a number of studies have shown that organisation of wound care of venous leg ulcer patients appeared to be important, and healing rates improved and the cost of care declined after the implementation of an evidence-based service.

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“…[15][16][17][18] In these patients, advanced dressings and skin grafts are generally used to achieve healing 21 and new regenerative approaches including the use of ADSCs have been proposed. 19 The positive effect of ADSCs is due to an increase in vascularization, which is fundamental to the healing process.…”

Section: Chronic Venous Leg Ulceration and The Potential Role Of Adipmentioning

confidence: 99%

Technique for intraoperatory harvesting of adipose derived stem cells: towards cell treatment of recalcitrant ulcers

Zollino

Sibilla²,

Gianesini

et al. 2017

Veins and Lymphatics

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Successful wound and ulcer repair remains a major biomedical challenge in the 21<sup>st</sup> Century. Innovative and alternative treatment options have been investigated over the last decade and stem cells application has been suggested as a possible novel therapy for regenerative medicine. In particular, stem cells derived from adipose tissue have been attracting a lot of attention in recent years as an alternative to the use of cells derived from bone marrow. This technical note describes the procedure introduced by Coleman for intraoperatory harvesting of adipose derived-stem-cells and proposes a rationale for using it in difficult wound healing and recalcitrant ulcers.

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Healing rates following venous surgery for chronic venous leg ulcers in an independent specialist vein unit

Abstract: This study shows that a significant proportion of ulcers currently managed conservatively can be healed by surgical intervention.

Cited by 14 publications

References 19 publications

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

Prognostic factors for delayed healing of venous leg ulcers

Technique for intraoperatory harvesting of adipose derived stem cells: towards cell treatment of recalcitrant ulcers

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