Postthrombotic or non-postthrombotic severe venous insufficiency: Impact of removal of superficial venous reflux with or without subcutaneous fasciotomy

Christenson, Jan T.

doi:10.1016/j.jvs.2007.03.046

Cited by 14 publications

(12 citation statements)

References 25 publications

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“…Several clinical trials have demonstrated that surgery performed to eradicate venous reflux in superficial veins notably reduced the recurrence rate of ulcers in a follow-up period of up to 3 years (Barwell et al, 2000; Zamboni et al, 2003; Barwell et al, 2004). Furthermore, as tissue pressures are increased in the affected limbs of patients with PTS, the role of fasciotomy in addition to surgical correction of superficial venous reflux was evaluated in a small study for the treatment of venous ulcers (Christenson, 2007). The addition of fasciotomy promoted healing in 11 out of 12 ulcers (92%), compared to only four out of 11 (36%) ulcers treated with surgical correction of superficial venous reflux alone (p=0.049) (Christenson, 2007).…”

Section: Treatment Of Ptsmentioning

confidence: 99%

“…Furthermore, as tissue pressures are increased in the affected limbs of patients with PTS, the role of fasciotomy in addition to surgical correction of superficial venous reflux was evaluated in a small study for the treatment of venous ulcers (Christenson, 2007). The addition of fasciotomy promoted healing in 11 out of 12 ulcers (92%), compared to only four out of 11 (36%) ulcers treated with surgical correction of superficial venous reflux alone (p=0.049) (Christenson, 2007). …”

Section: Treatment Of Ptsmentioning

confidence: 99%

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Incidence and cost burden of post-thrombotic syndrome

Ashrani

Heit

2009

J Thromb Thrombolysis

252

140

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Post-thrombotic syndrome (PTS) is a long-term complication of deep-vein thrombosis (DVT), manifesting as swelling, pain, edema, venous ectasia, and skin induration of the affected limb. PTS has been estimated to affect 23–60% of individuals with DVT, frequently occurring within 2 years of the DVT episode. Symptomatic DVT, post-operative asymptomatic DVT, and recurrent DVT are all risk factors for the development of PTS. Treatment of PTS is often ineffective and treatment-related costs represent a healthcare burden. Therefore, prevention of DVT is essential to reduce PTS, and thus improve outcomes and reduce overall healthcare costs. Although recommended by guidelines, appropriate DVT prophylaxis remains considerably underused. This review evaluates the incidence, risk factors, and economic impact of PTS. Increasing the awareness of PTS, and the methods to prevent this complication may help reduce its incidence, improve long-term outcomes in patients, and decrease resulting costs associated with treatment.

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Section: Treatment Of Ptsmentioning

confidence: 99%

Section: Treatment Of Ptsmentioning

confidence: 99%

Incidence and cost burden of post-thrombotic syndrome

Ashrani

Heit

2009

J Thromb Thrombolysis

252

140

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“…8 In chronic venous insufficiency, releasing the subcutaneous fluid by subcutaneous fasciotomy decreases the subcutaneous pressure. 9 The same principle is applied in the management of cellulitis. Early superficial subcutaneous fasciotomy in cellulitis can prevent the local complication like skin necrosis and progression to necrotising soft tissue infection.…”

Section: Study Backgroundmentioning

confidence: 99%

Subcutaneous pressure in cellulitis of the leg: can it be a predictor for early surgical intervention?

Nadarajan¹,

Chase²,

Roopavathana³

et al. 2016

Int Surg J

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INTRODUCTIONCellulitis is a spreading bacterial infection of the dermis and subcutaneous tissues. It occurs among both men and women. 1 The incidence of lower limb cellulitis was reported relatively high with 199 cases per 100,000 person-years in a population based study. 2 The most common causative organisms are Streptococcus pyogenes and Staphylococcus aureus. 3 The risk factors are toe web intertrigo, leg ulcers, trauma causing breach in the skin continuity, venous insufficiency, lymphedema, diabetes, obesity and immuno-compromised conditions. The most common risk factors for recurrence are venous insufficiency and lymphedema and previous episode of cellulitis. 4 The most common pathogenesis is the breach in skin integrity especially the toe web space. The Streptococci and Staphylococci produce toxins which cause inflammatory mediator release, resulting in the edema and skin changes.5 If the infection is persisting in the subcutaneous plane, the edema worsens leading to local complications resulting in systemic sepsis and multiple organ dysfunction. The common clinical ABSTRACT Background: Cellulitis, an infection of skin and subcutaneous tissue is usually managed conservatively and surgical intervention is required for local complications. The aim of this study was to correlate the subcutaneous pressure with the need for early surgical intervention in cases of lower limb cellulitis. Methods: We prospectively measured subcutaneous pressures in the normal leg and in the leg with cellulitis. Patients managed with parenteral antibiotics were compared to those managed with parenteral antibiotics and surgical intervention with standard statistical tests. Results: The median subcutaneous pressure was 3 mmHg and 9 mmHg in the normal leg and the other with cellulitis respectively. The mean of difference in subcutaneous pressure in legs with cellulitis compared to normal legs was 5.93 mmHg and 8.29 mmHg in the conservative group and surgical intervention group respectively. The difference in subcutaneous pressure between the normal leg and in the leg with cellulitis was statistically significant (p<0.001). The difference in the average pressure between surgical intervention group and conservative group was 2.36 mmHg and was statistically significant (p<0.05). The optimal threshold (difference in pressure) was identified as >=7 with sensitivity of 85.7% and specificity of 57.1%. Area under the ROC curve (SE) was 0.71 (0.10) with 95% CI (0.51, 0.87). Conclusions:The subcutaneous pressure in leg with cellulitis is a predictor for the need for early surgical intervention. It can be used as an adjunct in management and clinical decision making for cases of cellulitis of lower limbs.

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“…Neglen and associates have combined iliofemoral stenting with obliteration of superficial venous reflux and found that it is safe, effective and minimally invasive single-stage procedure [34]. Ablation of superficial venous reflux along with subcutaneous fasciotomy for chronic and recurrent venous ulcers improves ulcer healing or success of skin grafting [35]. …”

Section: Interventions To Correct Venous Refluxmentioning

confidence: 99%

Postthrombotic Syndrome: Surgical Possibilities

Khanna

Singh

2012

Thrombosis

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Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves.

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Postthrombotic or non-postthrombotic severe venous insufficiency: Impact of removal of superficial venous reflux with or without subcutaneous fasciotomy

Cited by 14 publications

References 25 publications

Incidence and cost burden of post-thrombotic syndrome

Incidence and cost burden of post-thrombotic syndrome

Subcutaneous pressure in cellulitis of the leg: can it be a predictor for early surgical intervention?

Postthrombotic Syndrome: Surgical Possibilities

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