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.

Topical Treatment of Venous Microangiopathy in Patients with Venous Ulceration with Essaven Gel

Angiology ◽  
2001 ◽  
Vol 52 (3_suppl) ◽  
pp. S29-S34 ◽  
Author(s):  
M.T. De Sanctis ◽  
L. Incandela ◽  
G. Belcaro ◽  
M.R. Cesarone
Keyword(s):  
Venous Insufficiency ◽  
Local Treatment ◽  
Venous Hypertension ◽  
Controlled Study ◽  
Control Group ◽  
Venous Ulceration ◽  
Venous Ulcers ◽  
And Control ◽  
Doppler Flux ◽  
Exchange Surface

The involvement of the microcirculation in chronic venous insufficiency (CVI), due to venous hypertension, causes venous hypertensive microangiopathy (VHM) and ulceration. VHM is char acterized by enlarged, convoluted capillaries; microvascular thrombosis; obliteration of some capillaries; increase in flux, permeability, and edema and altered microlymphatics. PO 2 is decreased and CO2 increased. Capillary exchanges are altered and nutritional alterations even tually lead to venous ulcers. Edema is associated with increased capillary pressure, reduced clearance, and increased exchange surface of capillaries, which become tortuous and glomerular-like. The aim of this randomized, placebo-controlled study was to evaluate local treatment with Essaven gel (EG) in subjects with venous microangiopathy and ulcers. Measurements of laser Doppler flux, PO2, and PCO2 in standardized conditions showed positive changes (a significant decrease of the abnormally increased flux and CO2 while PO2 increased) in the EG treatment group. Changes in the placebo and control group were more limited (changes in the placebo group were mainly associated with skin manipulation when placebo- EG was applied). In conclusion, Essaven gel, in comparison with placebo, acutely improves the microcirculation in VHM even with a single acute application.

Microvascular Changes in Venous Hypertension due to Varicose Veins After Standardized Application of Essaven Gel

Angiology ◽  
2001 ◽  
Vol 52 (3_suppl) ◽  
pp. S11-S16 ◽  
Author(s):  
M.R. Cesarone ◽  
M.T. De Sanctis ◽  
L. Incandela ◽  
G. Belcaro ◽  
M. Griffin
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Local Treatment ◽  
Venous Hypertension ◽  
Controlled Study ◽  
Single Application ◽  
Venous Ulceration ◽  
Microvascular Changes ◽  
Capillary Bed ◽  
Exchange Surface

The involvement of the microvascular structure in chronic venous insufficiency (CVI) causes venous hypertensive microangiopathy (VHM), which leads to venous ulceration. VHM is char acterized by enlarged and ramified capillaries, increased flux and capillary permeability, edema, and altered function of microlymphatics. TcPO2 is decreased and CO2 increased. This perfu sional paradox is caused by hyperperfusion in the deep skin layers with hypoperfusion of superficial nutritional capillaries. Exchanges in the capillary bed are altered. Nutritional skin alterations eventually lead to venous ulceration. Edema is the consequence of increased capillary pressure, reduced clearance, and by an increased exchange surface of capillaries. The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in 22 subjects with VHM due to severe varicose veins, treated with a single application. Measurements of flux, PO2 and PCO2 in standardized conditions of applica tion indicated a significant decrease of the abnormally increased flux and CO2; PO2 increased in the treatment group. Essaven gel, in comparison with placebo and controls acutely improves the microcirculation in VHM even with a single application.

Microangiopathy and Venous Ulceration: Topical Treatment with Essaven Gel

Angiology ◽  
2001 ◽  
Vol 52 (3_suppl) ◽  
pp. S17-S21 ◽  
Author(s):  
L. Incandela ◽  
G. Belcaro ◽  
M.R. Cesarone ◽  
M.T. De Sanctis ◽  
M. Griffin
Keyword(s):  
Venous Insufficiency ◽  
Local Treatment ◽  
Venous Hypertension ◽  
Controlled Study ◽  
Control Group ◽  
Venous Ulceration ◽  
Venous Ulcers ◽  
And Control ◽  
Doppler Flux ◽  
Exchange Surface

The involvement of the microcirculation in chronic venous insufficiency (CVI) due to venous hypertension causes venous hypertensive microangiopathy (VHM) and venous ulceration. VHM is characterized by the presence of enlarged convoluted capillaries; microvascular thrombosis with obliteration of some capillaries; increase in flux, permeability, and edema; and altered function of microlymphatics. PO2 is decreased and CO2 increased. Capillary exchanges are altered, and nutritional alterations eventually lead to venous ulcers. Edema is associated with increased capillary pressure, reduced clearance, and an increased exchange surface of capillaries, which become tortuous and glomerular-like. The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in 28 subjects with venous microangiopathy due to severe CVI and ulcers treated with a single acute application. Measurements of laser Doppler flux, PO2 and PCO2 in standardized conditions of application showed positive microcirculatory changes (significant decrease of the abnormally increased flux and CO2 while PO 2 increased) in the EG treatment group. Changes in the placebo and control group were more limited (changes in the placebo group were mainly associated with skin manipulation when placebo-EG was applied). ln conclusion, Essaven gel, in comparison with placebo, acutely improves the microcirculation in VHM 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.

Effect of Compression Stockings on the Skin Microcirculation in Chronic Venous Insufficiency

1995 ◽  
Vol 10 (1) ◽  
pp. 5-11 ◽  
Author(s):  
A. Abu-Own ◽  
J. H. Scurr ◽  
P. D. Coleridge Smith
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Laser Doppler ◽  
Controlled Study ◽  
Fibre Laser ◽  
Medial Malleolus ◽  
Compression Stocking ◽  
Compression Stockings ◽  
Median Increase ◽  
The Subject

Objective: To use a single fibre laser Doppler fluxmeter to assess the microcirculatory effects of compression stockings. Design: Controlled study comprising patient and control groups. Setting: Department of Surgery, University College London Medical School, London, UK. Patients and participants: Ten patients with lipodermatosclerosis caused by chronic venous insufficiency and 10 control subjects. Interventions: Measurements were made from the liposclerotic skin of patients and 8 cm above the medial malleolus in controls. Laser Doppler flux (LDF), blood ce velocity (BCV) and concentration of moving blood cells (CMBC) were recorded with the subject lying supine. A class II graduated compression stocking was applied to the leg and laser Doppler recordings were repeated. The protocol was repeated with the subject sitting. Main outcome measures: The effects of a compression stocking on LDF, BCV and CMBC in the horizontal and sitting positions were measured. Results: In patients in the supine position, the compression stocking resulted in a 28% median increase in LDF ( p = 0.03), with a corresponding 29% median increase in BCV. There was no significant change in CMBC. In the sitting position, the compression stocking caused a 105% median increase in LDF ( p < 0.01) due to a corresponding 89% median increase in BCV ( p = 0.01); there was only 25% median increase in CMBC. The effects of compression in controls were similar to those in patients. Conclusion: Compression stockings may be effective in the treatment of chronic venous insufficiency by increasing the microcirculatory flow velocity.

Four-Week Treatment with Essaven Gel in Diabetic Microangiopathy

Angiology ◽  
2001 ◽  
Vol 52 (3_suppl) ◽  
pp. S49-S55 ◽  
Author(s):  
M.T. De Sanctis ◽  
M.R. Cesarone ◽  
L. Incandela ◽  
G. Belcaro ◽  
A. Ricci ◽  
...  
Keyword(s):  
Placebo Group ◽  
Treatment Period ◽  
Local Treatment ◽  
Skin Lesions ◽  
Local Application ◽  
Diabetic Microangiopathy ◽  
Controlled Study ◽  
Control Group ◽  
Treatment Changes ◽  
Average Laser

The involvement of the microcirculation in diabetic microangiopathy (DM) may be the cause of severe incapacitation and ulceration. DM is characterized by a diffuse increase in skin flux, reduction in venoarteriolar response, and increased permeability, resulting in edema. In this condition capillary exchanges are altered and nutritional alterations eventually lead to skin lesions and ulcers. The aim of this randomized, placebo-controlled study was to evaluate the effect of local (foot) treatment with Essaven gel (EG) in 15 subjects with DM and neuropathy and treated with local application of EG for 4 weeks. Measurements of composite, average laser Doppler (LDF) flux (ten measurements points), in standardized conditions showed a significant decrease in flux in the EG group. The flux decrease was present even after 1 week after the suspension of treatment. Changes in the control group were not significant. In the placebo group, variations were limited (associated with skin manipulation and gel application). In conclusion local treatment for 4 weeks with standardized application of EG improves the microcirculation in subjects with DM. The changes are detectable even 1 week after the end of the treatment period.

Changes of Skin Microcirculation in Patients with Chronic Venous Insufficiency Assessed by Laser Doppler Fluxmetry and Transcutaneous Oxymetry

1994 ◽  
Vol 9 (4) ◽  
pp. 158-163 ◽  
Author(s):  
A. Creutzig ◽  
L. Caspary ◽  
K. Alexander
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Capillary Flow ◽  
Venous Hypertension ◽  
Laser Doppler ◽  
General Effect ◽  
Transcutaneous Oxygen ◽  
Microcirculatory Disturbances ◽  
Transcutaneous Oxygen Pressure ◽  
Open Prospective Study

Objective: To evaluate whether microcirculatory disturbances of the skin in patients with chronic venous insufficiency are a generalized phenomenon or restricted to visible skin changes. Design: Open, prospective study in patients and healthy, age-matched subjects. Setting: Department of Angiology, Hannover Medical School. Patients: Seventy-one patients with chronic venous insufficiency. Measurements: Transcutaneous oxygen pressure (tc Po2) at electrode core temperatures of 37°C and 44°C and laser Doppler flux (LDF) were measured simultaneously in different regions of the legs. Results: On the forefoot, tc Po2 (37°C) at rest and tc Po2 (44°C) during arterial ischaemia were significantly higher in patients ( P<0.05), increasing with the severity of chronic venous insufficiency. Conclusions: Cutaneous capillary flow on the forefoot is increased in patients with chronic venous insufficiency, demonstrating the general effect of venous hypertension.

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