Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer

Malas MB, Quasi U, Lazarus G, et al. J Vasc Surg: Venous Lymphat Disord. 2014;2:212-25. This review was contracted by the US Agency for Health Care Research and Quality (AHRQ) for the Johns Hopkins Evidence-based Practice Center. Two key questions were developed: 1. For patients with a chronic venous ulcer (CVU), what are the benefits and harms of surgical procedures? 2. For patients with a CVU, what are the comparative benefits and harms of different surgical procedures for a given type of venous reflux and obstruction? A systematic review was conducted and 10 646 citations were identified, of which, 22…

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Operative treatment in postthrombotic syndrome: an update

Oscar MALETI1, Marzia LUGLI2, Michel PERRIN3 1. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy Interuniversity Center of Phlebolymphology. 2. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy. 3. Associate Professor of Surgery Grenoble and for Institution Unité de Pathologie Vasculaire Jean Kunlin, Clinique du Grand Large, Chassieu, Lyon, France. ABSTRACT Postthrombotic deep vein obstruction and/or incompetence can lead to severe chronic venous insufficiency in a significant number of cases. Postthrombotic lesions are essentially of two types: (i) obstruction of various degrees; and (ii) valve destruction with subsequent reflux. These two elements are variously present at different levels. The most…

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Local treatment of venous leg ulcers

Patricia SENET Hôpital Tenon Paris, France ABSTRACT The current standard of care for chronic venous ulcers involves the use of compression bandages. Dressings are applied beneath the compression and are used to control the exudates and to maintain the wound in a moist environment. Modern dressings are occlusive or semi-occlusive, classified according to their physical composition. Published systematic reviews of the value of different types of dressings in the management of chronic wounds provide only weak levels of evidence of their clinical efficacy, in terms of healing rate. Nevertheless, the indications for modern dressings were recently determined according to a…

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Shave therapy for venous ulcers – a review and current results

Hans Joachim HERMANNS Peter WALDHAUSEN Clinic for Vascular Medicine, Venous and Wound Care Center, Krefeld, Germany SUMMARY Shave therapy was established by Schmeller, mostly in Europe, and is not common in the international literature. The technique involves layered tangential and only suprafascial necrosectomy and fibrosectomy of nonhealing venous leg ulcers, combined with simultaneous skin grafting. In spite of very good long-term results confirmed by several investigators and published as a retrospective analysis, there are no prospective and randomized studies. Long-term healing rates between 70% and 80% for recalcitrant venous leg ulcers are very good, and no other current method is…

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Amniotic membrane: An innovative treatment of refractory vascular ulcers?

Francis PESTEIL* Mireille DROUET** Marie-Claire ROUSANNE*** Philippe LACROIX* * Service de Chirurgie Thoracique, Cardio- Vasculaire et Angiologie, CHU Dupuytren, Limoges, France ** Service d’Immunologie, CHU Dupuytren, Limoges, France *** Etablissement français du sang Aquitaine- Limousin ABSTRACT Mixed arterial and venous ulcers often heal poorly if there is no revascularization, as observed in the elderly, diabetics, and chronic renal failure patients who often have diffuse, distal, and calcified vascular lesions. Treatment therefore is based on optimized local wound care, pain control, and management of the risk of infection inherent in these types of patients with chronic wounds. Current avenues of research…

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Neovalve reconstruction in postthrombotic syndrome. Technique, indications, and results

Oscar MALETI Marzia LUGLI Department of Cardiac, Thoracic, Vascular Surgery Hesperia Hospital Modena, Italy ABSTRACT Patients with leg venous ulcer (C6 patients according to the CEAP classification) affected by deep venous reflux often fail to respond to conservative therapies, and the presence of non-healing or recurrent ulcers may lead one to consider surgery. However, even if surgery is properly indicated, traditional techniques such as femoral transposition and valve transplantation are not always suitable, and in these cases a de novo valve reconstruction represents a surgical opportunity. Our neovalve reconstruction technique consists in creating an intimal flap by performing a wall…

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