The effect of compression ulcer stockings on the capillary filtration rate and the formation of edema

Phlebologie ◽  
2011 ◽  
Vol 40 (05) ◽  
pp. 245-250 ◽  
Author(s):  
O. Wolff ◽  
T. D. Wentel ◽  
S. W. I. Reeder ◽  
H. A. M. Neumann
Keyword(s):  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
Filtration Rate ◽  
Venous Insufficiency ◽  
Total Population ◽  
Venous Pressure ◽  
Capillary Leakage ◽  
Edema Formation ◽  
Capillary Filtration ◽  
Venous Ulcers

SummaryIncreased ambulatory venous pressure is the key feature of chronic venous insufficiency, and causes capillary leakage and venous edema. This capillary leakage can be measured with plethysmography and is called the capillary filtration rate (CFR).Reduction of the CFR leads to less edema formation and improves the healing of venous ulcers. Aim: To show that the use of compression ulcer stockings reduces the CFR. Methods: The capillary filtration rate of both legs of 17 patients, 6 with chronic venous insufficiency and 11 healthy subjects was measured with both (day and night) stockings, only the night stocking and without stockings. Results: The reduction of the CFR was significant (p <0.0001) for the total population in the group wearing 2 stockings versus 1 stocking (CFR=0.019 vs. 0.084 ml/100 ml/min), 1 stocking versus no stocking (CFR=0.149 vs. 0.084 ml/100 ml/min) and 2 stockings versus no stockings (CFR=0.019 vs. 0.149 ml/100 ml/ min). Conclusion: Compression ulcer stockings are highly effective in reducing CFR and thus reducing edema formation, which leads to improved healing of venous ulcers.

Changes in Microcirculation in Venous Ulcers with Essaven Gel

Angiology ◽  
2001 ◽  
Vol 52 (3_suppl) ◽  
pp. S23-S27 ◽  
Author(s):  
L. Incandela ◽  
G. Belcaro ◽  
M.R. Cesarone ◽  
M.T. De Sanctis ◽  
M. Griffin
Keyword(s):  
Placebo Group ◽  
Treatment Group ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Local Treatment ◽  
Venous Hypertension ◽  
Controlled Study ◽  
Single Application ◽  
Venous Ulcers

Microcirculatory changes in chronic venous insufficiency (CVI) due to venous hypertension produce venous hypertensive microangiopathy (VHM) and lead to ulceration. VHM is charac terized by enlarged, convoluted capillaries; increase in flux, permeability, and edema; and altered microlymphatics. PO2 is decreased and CO2 increased. Capillary exchanges are altered and nutritional alterations in association with microtrauma may cause venous ulcers. The aim of this pilot, cross-over, randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) (single acute application) in 10 subjects with VHM and venous ulcers. The study was structured over 3 days: day 1 was used for the control evalua tion for all patients. One group was randomized for the sequence placebo (day 2) and EG the following day; the second group with the sequence EG (day 2) and placebo (day 3). Indepen dently from the sequence, measurements of flux and PO2 in standard conditions showed positive changes (significant decrease of the abnormally increased flux, PO2 increase) in the EG treatment group. Changes in the placebo group were limited and associated with skin manip ulation. In conclusion, EG acutely improves microcirculation in limbs with VHM and ulceration even with a single application.

Surgical Treatment of the Superficial and Perforating Veins

2000 ◽  
Vol 15 (3-4) ◽  
pp. 131-136 ◽  
Author(s):  
P. Gloviczki
Keyword(s):  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
High Ligation ◽  
Ulcer Recurrence ◽  
Perforating Veins ◽  
Post Thrombotic Syndrome ◽  
Venous Ulcers ◽  
Ulcer Surgery

Objective: To review the techniques and results of surgical treatment of the superficial and perforating veins in patients with chronic venous insufficiency. Methods: The current techniques used at the Mayo Clinic for treatment of simple varicose veins and venous ulcers are presented. Results of subfascial endoscopic perforator vein surgery (SEPS) are discussed and data from large centres are tabulated. Results are compared with those reported following non-operative management. Synthesis: High ligation and invagination stripping of the incompetent segment of the saphenous vein, with stab avulsion of branch varicosities, is the optimal surgical technique to ablate superficial venous incompetence. SEPS is safer than open perforator vein ligation and is the technique of choice to interrupt incompetent perforating veins. A review of 12 series on SEPS, that included 361 limbs, found an ulcer recurrence rate of 10% in those 211 patients who underwent ablation of superficial reflux together with SEPS. One hundred and fifty limbs had SEPS alone, without saphenous stripping: ulcer recurrence in this group at a mean of 23 months was 12%. Results in primary valvular incompetence were significantly better than in post-thrombotic syndrome. Conclusions: Ablation of superficial reflux remains the main surgical treatment of all forms of chronic venous insufficiency. SEPS is safe and effective to interrupt medial calf perforators and results in rapid ulcer healing and low recurrence in patients with primary valvular incompetence. The treatment of post-thrombotic syndrome remains a challenge. Results of the North American Venous Ulcer Surgery (NAVUS) trial, a prospective, randomised, multicentre study, will be required to provide level 1 evidence of the effectiveness of surgical treatment over medical therapy in the treatment of venous ulcers.

Chronic Venous Insufficiency and the Therapeutic Effects of Daflon 500 mg

Angiology ◽  
2005 ◽  
Vol 56 (6_suppl) ◽  
pp. S21-S24 ◽  
Author(s):  
John J. Bergan
Keyword(s):  
Shear Stress ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Vena Cava ◽  
Venous Hypertension ◽  
Therapeutic Effects ◽  
Inflammatory Cascade ◽  
Perforating Veins ◽  
Days Of Therapy

Chronic venous insufficiency is linked to venous hypertension and forces of shear stress on the endothelium. Venous hypertension depends upon two forces: the weight of a column of blood from the right atrium transmitted through the valveless vena cava and iliac veins to the femoral vein, and pressure generated by contracting skeletal muscles of the leg transmitted through failed perforating veins. When valve failure occurs in superficial axial veins and perforating veins, the venous pressure in the veins and venules of the skin and subcutaneous tissue is raised. The skin changes in chronic venous insufficiency are directly related to the severity of the venous hypertension. Also, pathologic changes in the valves are linked to venous hypertension and leukocyte infiltration and activation. It is hypothesized that acute venous pressure elevations cause a shift in the venous hemodynamics with changes in wall shear stress. This initiates the inflammatory cascade. Daflon 500 mg ameliorates the effects of chronic inflammation. In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. Because venous insufficiency is linked to venous hypertension and an inflammatory reaction, it appears that Daflon 500 mg 2 tablets daily shows a great potential for accomplishing blockade of the inflammatory cascade.

scholarly journals The Influence of Compressive Stockings on the Haemodynamics in the Lower Extremities

1988 ◽  
Vol 3 (3) ◽  
pp. 147-154 ◽  
Author(s):  
A.J.M. Brakkee ◽  
J.P. Kuiper
Keyword(s):  
Healthy Subject ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Lower Extremities ◽  
Limb Volume ◽  
Pump Function ◽  
Muscle Pump ◽  
Elastic Stocking ◽  
Tissue Compression

The influence of an elastic stocking upon the venous muscle pump function in a healthy subject and in a patient with chronic venous insufficiency is discussed. Taking into account the alinear relationship between venous pressure and limb volume the experiences concerning the effects of tissue compression, some of which seem to be contradictory, are clarified.

Alterations of filtration coefficients in pulmonary edema of different pathogenesis

1992 ◽  
Vol 73 (6) ◽  
pp. 2396-2402 ◽  
Author(s):  
T. Koch ◽  
H. P. Duncker ◽  
S. Rosenkranz ◽  
H. Neuhof ◽  
K. Van Ackern
Keyword(s):  
Arachidonic Acid ◽  
Pulmonary Edema ◽  
Barrier Function ◽  
Diclofenac Sodium ◽  
Venous Pressure ◽  
Lung Weight ◽  
Edema Formation ◽  
Capillary Filtration ◽  
Control Value ◽  
Isolated Cell

Different pathomechanisms in the development of pulmonary edema are being discussed. We investigated the effect of pathogenetically varying forms of edema on lung vascular barrier function in isolated cell-free perfused rabbit lungs. As an index of permeability, capillary filtration coefficients (Kfc) were determined from the slope of lung weight change over periods of stepwise venous pressure elevation (5, 7.5, and 10 mmHg) before (controls) and 60 min after edema induction. Edema was induced by venous congestion (n = 6), by application of arachidonic acid in the presence of diclofenac sodium (n = 6), and by elastase application (n = 6). Control values ranged from 0.28 to 0.51 ml.min-1 x mmHg-1 x 100 g-1. Kfc was significantly enhanced after edema induction up to 243% of control value in the hydrostatic edema, 357% in the arachidonic acid edema, and 594% in the elastase edema. When the alterations in capillary filtration due to the different types of edema were compared, Kfc was significantly higher in the proteinase edema, indicating an irreversibly damaged barrier function. These data exemplify different pathophysiological characteristics due to the pathogenesis of interstitial edema formation.

scholarly journals Modulation of Circulating Cytokine-Chemokine Profile in Patients Affected by Chronic Venous Insufficiency Undergoing Surgical Hemodynamic Correction

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Veronica Tisato ◽  
Giorgio Zauli ◽  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Laura Brunelli ◽  
...  
Keyword(s):  
Varicose Vein ◽  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
General Circulation ◽  
Venous Insufficiency ◽  
Ex Vivo ◽  
Hemodynamic Forces ◽  
Circulating Levels

The expression of proinflammatory cytokines/chemokines has been reported inin vitro/ex vivosettings of chronic venous insufficiency (CVI), but the identification of circulating mediators that might be associated with altered hemodynamic forces or might represent innovative biomarkers is still missing. In this study, the circulating levels of 31 cytokines/chemokines involved in inflammatory/angiogenic processes were analysed in (i) CVI patients at baseline before surgical hemody namic correction, (ii) healthy subjects, and (iii) CVI patients after surgery. In a subgroup of CVI patients, in whom the baseline levels of cytokines/chemokines were analyzed in paired blood samples obtained from varicose vein and forearm vein, EGF, PDGF, and RANTES were increased at the varicose vein site as compared to the general circulation. Moreover, while at baseline, CVI patients showed increased levels of 14 cytokines/chemokines as compared to healthy subjects, 6 months after surgery, 11 cytokines/chemokines levels were significantly reduced in the treated CVI patients as compared to the CVI patients before surgery. Of note, a patient who exhibited recurrence of the disease 6 months after surgery, showed higher levels of EGF, PDGF, and RANTES compared to nonrecurrent patients, highlighting the potential role of the EGF/PDGF/RANTES triad as sensitive biomarkers in the context of CVI.

Cutaneous Blood Flow in Legs with Severe Chronic Venous Insufficiency Recorded before and after a Single Treatment Using Intermittent Pneumatic Compression

1996 ◽  
Vol 11 (1) ◽  
pp. 30-33 ◽  
Author(s):  
K. Malanin ◽  
P. J. Kolari ◽  
A. Haapanen ◽  
I. Helander ◽  
V. K. Havu
Keyword(s):  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
Venous Insufficiency ◽  
Intermittent Pneumatic Compression ◽  
Laser Doppler ◽  
Sitting Position ◽  
Single Treatment ◽  
Recumbent Position ◽  
Doppler Flowmetry ◽  
Before And After

Objective: To investigate the skin laser Doppler flux (LDF) in legs with severe chronic venous insufficiency (CVI). Design: Comparison of the legs with severe CVI with the healthy legs and with the patients' contralateral legs. Setting: Department of Dermatology, University of Turku, Turku, Finland. Patients and control subjects: Ten patients and eight age-matched subjects with healthy legs. Interventions: A single treatment using intermittent pneumatic compression (IPC) of 45 min duration. Main outcome measures: Laser Doppler flowmetry with the subjects in a recumbent and a sitting position. Results: The LDF values were higher for the legs with severe CVI than for the legs of healthy subjects ( p<0.001 in a recumbent and p<0.01 in a sitting position). A single IPC increased the LDF in a recumbent position in the patients' legs with severe CVI ( p=0.019) but had no significant effect on the LDF value in the sitting position. The venoarteriolar response was significantly better in the legs with severe CVI than in the legs of healthy subjects ( p<0.05). Conclusions: The LDF is increased in legs with severe CVI and a single IPC further increases it in a recumbent position. The venoarteriolar response is not impaired in legs with severe CVI.

Microcirculation disturbances in different stages of chronic venous insufficiency

Phlebologie ◽  
2001 ◽  
Vol 30 (01) ◽  
pp. 11-15 ◽  
Author(s):  
Pavel Poredoš ◽  
Igor Švab ◽  
Josip Car ◽  
Blaž Mlačak
Keyword(s):  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
Venous Insufficiency ◽  
Cuff Pressure ◽  
Arterial Occlusion ◽  
Flow Regulation ◽  
Venous Hypertension ◽  
Laser Doppler ◽  
Specific Flow ◽  
Doppler Flux

Summary Objectives: The aim of this study was to investigate patients with different clinical stages of chronic venous insufficiency (CVI) by laser Doppler fluxmetry (LDF) in order to asses whether these clinical entities correspond to specific flow regulation. Methods: 3 groups of subjects were incorporated in the study. Microcirculation investigations were carried out at rest and after hemodynamics tests. Changes in the laser Doppler flux minus the biological zero value were measured after 3 minutes of arterial occlusion and by experimental venous hypertension (40 and 70 mmHg) and expressed relatively to the pretest resting value. Results: Resting LDF was significantly higher in patients with CVI II and CVI III stage as compared to the both groups with healthy subjects and the group with CVI I stage (p <0.001). In patients with CVI II and CVI III stage LDF remained nearly unchanged after arterial occlusion (6% increase vs. 342% in healthy subjects and 214% increase in patients with CVI I (p <0.001 vs. p <0.001). Experimental venous hypertension (cuff pressure 70 mmHg) led to profound reduction of flux in all 3 groups (I: –90%; II: –91.7%; III: –91.4%). At the same time, absolute LDF values during experimental venous hypertension (40 and 70 mmHg) were significantly higher in patients with CVI II and III in comparison to patients with CVI I and healthy subjects (p <0.001 vs. p <0.001). Conclusion: It seems that in severe CVI patients the venoarteriolar reflex, despite being comparable in magnitude to that in healthy subjects, may nonetheless be insufficient to reduce LDF during experimental venous hypertension to the level similar to that in healthy subjects and patients with CVI I.

New Advances in the Understanding of the Pathophysiology of Chronic Venous Insufficiency

Angiology ◽  
2001 ◽  
Vol 52 (1_suppl) ◽  
pp. S27-S34 ◽  
Author(s):  
Geert W. Schmid-Schönbein ◽  
Shinya Takase ◽  
John J. Bergan
Keyword(s):  
Inflammatory Reaction ◽  
Tissue Damage ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Fluid Shear Stress ◽  
Subcutaneous Tissue ◽  
Venous Pressure ◽  
Current Evidence ◽  
Venous Valve ◽  
Trigger Mechanisms

Chronic venous insufficiency (CVI) is inseparably linked to elevated venous pressure and is accompanied by vascular, dermal, and subcutaneous tissue damage and restructuring. Abundant evidence exists both in humans and in experimental models to suggest that the tissue damage may be initiated by generation of an inflammatory reaction. inflammatory indi cators include elevation of endothelial permeability; attachment of circulating leukocytes to the endothelium; infiltration of monocytes, lymphocytes, and mast cells into the connective tissue; and development of fibrotic tissue infiltrates and several molecular markers, such as growth factor or membrane adhesion molecule generation. Indicators of an inflammatory reaction are already detectable at early stages of CVI and may be involved in the development of primary venous valve dysfunction. One of the important questions is to identify trigger mechanisms for the inflammatory reaction in CVI. Current evidence suggests that, among several possible mechanisms (hypoxia, humoral stimulation), a shift in fluid shear stress from normal physio logical levels and endothelial distension under the influence of elevated venous pressure may serve as trigger mechanisms for inflammation.

Sign in / Sign up

Export Citation Format

Share Document